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Case Reports
. 2023 Apr 26;4(2):e314.
doi: 10.1097/PG9.0000000000000314. eCollection 2023 May.

Treatment of Esophageal Perforation: Endoscopic Vacuum-Assisted Closure

Grafton S Barnett  1 , Kathryn M Kimsey  1 , Hester F Shieh  2 , C Jason Smithers  2 , Jonathan M de Vries  1 , Jack Mouch  1 , Michael Wilsey  1
Affiliations
Case Reports

Treatment of Esophageal Perforation: Endoscopic Vacuum-Assisted Closure

Grafton S Barnett et al. JPGN Rep. .

Abstract

Surgical repair of type C esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is complicated by an anastomotic leak in 10%-30% of cases with associated morbidity. A novel procedure in the pediatric population, endoscopic vacuum-assisted closure (EVAC), accelerates the healing of esophageal leaks by using the effects of VAC therapy, including fluid removal and stimulation of granulation tissue formation. We report 2 additional cases of chronic esophageal leak treated with EVAC in EA patients. The first is a patient with a previously repaired type C EA/TEF and left congenital diaphragmatic hernia complicated by an infected diaphragmatic hernia patch erosion into the esophagus and colon. Additionally, we discuss a second case using EVAC for early anastomotic leak following type C EA/TEF repair in a patient who was later found to have a distal congenital esophageal stricture.

Keywords: anastomosis; hernia; pediatrics; sponge; tracheoesophageal fistula.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
A and B) Two views of the indwelling chest tube (arrow) are seen through the esophagoscope erroneously near the esophageal perforation. This chest tube was removed and replaced with a shorter tube that would not protrude into the esophageal lumen. The endoscope forceps were used to grasp the new chest tube and maneuver it into an ideal position with direct visualization of the chest cavity (not pictured). C) Esophageal perforation, 1 week after EVAC treatment. Esophageal perforation was visualized on the left, and the NGT on the right. EVAC = endoscopic vacuum-assisted closure; NGT = nasogastric tube.
FIGURE 2.
FIGURE 2.
A) Vacuum sponge has been cut to size to cover the anastomotic leak. B) Proximal portion of vacuum sponge with a 2-0 Prolene tie (see article) placed to aid in endoscopic sponge removal. C) Fluoroscopy is used to position the vacuum sponge and JP drain apparatus across the esophageal perforation.
FIGURE 3.
FIGURE 3.
A) Contrast esophagram 1 month after starting EVAC therapy showing a left-lateral outpouching from thoracic scar tissue but no esophageal leakage. B) Healed esophageal perforation 1 year later with persistent diverticulum. EVAC = endoscopic vacuum-assisted closure.
See this image and copyright information in PMC

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