Esophageal perforations due to foreign body impaction in children

• Published in: Journal of pediatric surgery Vol. 50; no. 8; pp. 1260 - 1263
• Main Authors: Peters, Nitin James, Mahajan, J.K, Bawa, Monika, Chabbra, Ashish, Garg, Ravi, Rao, K.L.N
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2015
• Subjects: Algorithms; Child; Child, Preschool; Decision Support Techniques; Eating; Esophageal Perforation - etiology; Esophageal Perforation - surgery; Esophagoscopy; Esophagostomy; Esophagotomy; Esophagus; Esophagus - surgery; Female; Foreign Bodies - complications; Foreign Bodies - surgery; Foreign body; Humans; Infant; Male; Pediatrics; Perforation; Surgery; Tracheoesophageal fistula; Treatment Outcome; Foreign body; Perforation; Esophagotomy; Tracheoesophageal fistula; Esophagus; Esophagoscopy
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2015.01.015

Abstract Aims The treatment of perforating esophageal foreign body impaction (FBI) is complex and unclear. We present the outcome of surgical treatment of esophageal perforations due to FBI in children along with a management algorithm. Methods During a period of 7 years, 7 cases of esophageal perforations due to foreign body (FB) ingestion were referred to our unit. We analyzed the FB types, lodging duration and location, complications, and the surgical approaches. Results There were 4 male and 3 female patients. Mean age was 28 months (5 months–6 years). Six patients had metal FBs of variable shapes and 1 had glass marble. Three patients had witnessed history of FB ingestion. Duration of ingestion was variable and unknown in half of the patients. The site of impaction was cervical (1) and thoracic (5) esophagus. One patient had a marble as FB in the superior mediastinum. One patient manifested with features of perforation after removal of the impacted FB and 5 patients presented with perforations. Two patients presented with subcutaneous emphysema. One patient had trachea-esophageal fistula (TEF) after disc battery ingestion. Rigid esophagoscopy failed in 4 out of 6 patients. Five patients underwent thoracotomy, and repair with a pleural patch reinforcement. One patient had lateral esophagotomy in the cervical esophagus for removal of the impacted FB. Mediastinal FB was removed without opening the esophagus. All the patients were discharged uneventfully. Conclusions Esophageal perforation following FBI is rare and requires prompt treatment. Surgical treatment tailored to the needs of individual patients is associated with a successful outcome and decreased morbidity.