Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Abstract

Aim: To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.

Materials and methods: Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.

Results: Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.

Conclusion: Esophageal injuries though rare can be potentially devastating and life-threatening.

Keywords: Corrosive injury; esophagus; foreign body.

Figure 1

Alkaline battery complications of esophageal erosions (endoscopic picture), trachea esophageal fistula (solid arrow), pseudodiverticulum (empty arrow) and spontaneous closure of trachea esophageal fistula at 4 months

Figure 2

Neck X-ray showing various sharp foreign bodies