NON-SURGICAL MANAGEMENT FOR LATE ESOPHAGEAL PERFORATION IN CHILDREN

Abstract

Background: Even today, esophageal perforation remains a lethal medical condition with a high rate of morbidity and mortality. We encountered numerous pediatric cases of esophageal perforation that presented in late time. This study examined vigorous conservative approaches to get the maximum benefit from forceful pleural contamination irrigation without taking them to surgery.

Methods: Between 2013 and 2020, 21 patients who had esophageal perforations that were discovered 24 hours after the event were treated. Perforations were found in the esophageal parts of the neck, thorax, and abdomen. The causes of perforation were traumatic in 3 cases, post-corrosive in 6 cases and iatrogenic in 12 cases

Results: Conservative treatment was provided to each of the twenty one patients. There was only one death record (4.8%) in a post-corrosive perforation case. Twenty out of twenty-one patients (95.2%) are survived without undergoing surgery. Only one case required surgery because the abdominal portion of the esophagus had developed a perforation.

Conclusions: Effective treatment of sepsis with a chest drain and irrigation, together with the placement of a nasogastric tube for feeding, reduces mortality, avoids potential peri-operative complications, and improves the likelihood of esophageal healing. Esophageal perforation remains a well-known devastating complication, with higher death rates in late presented cases. A number of studies recommended an aggressive surgical strategy to manage this issue, such as vigorous surgical drainage, primary esophageal resection, 2-stage resection and/or esophagostomy, or primary surgical repair. We discovered that extensive conservative treatment might produce superior results than documented surgical cases.