ABSTRACT Shree

Reconstructive strategy after failed management of esophageal perforation in corrosive stricture in a 6 year old child

 

Presenting Author : Shree Krishnamoorthy – 4th Year MBBS, SRIHER (DU), Chennai, India

Co- Authors :

M Kanagavel

Apsara Chandramohan

Aditya Balaji

Professor S. M. Chandramohan, Professor, Surgical Gastroenterology, SRIHER (DU), Chennai, India

Background :

The incidence of accidental caustic agent ingestions in the paediatric age group in India was found to be 3.1% of all poisonings (76 out of 2494 reported cases) according to a report published by The National Poisons Information Centre, AllIndia Institute of Medical Sciences, New Delhi.

It can cause severe complications by development of oesophageal strictures. It is a paediatric emergency warranting prompt action.

Case report :

Here we present a case of a 6 year old baby who had accidental ingestion of corrosive in OCT 2015 and developed corrosive esophageal stricture. Between the time of ingestion upto FEB 2018, she has undergone treatment in a different centre. During that period,she had undergone 23 dilation procedures. In OCT 2017, the attempted dilatation led to an oesophageal perforation, which was managed conservatively. In NOV 2017, a gastrostomy was done. In DEC 2017 Fokers stage-1 procedure had been attempted which failed, hence a right cervical esophagostomy was done. Following this the patient was referred to our institute. At our centre, she was taken up for surgery after optimisation. Midline abdominal entry was made. Gastrostomy tube removed and the site was closed transversely with 3-0 PDS interrupted sutures. Gastric mobilisation was done based on right gastric and right gastro-epiploic arcade. GE junction disconnected,  retrosternal tunnelling was done. Stomach was tubularised and taken up retrosternally to complete esophago-gastric anastamosis. Post op recovery was uneventful. Discharge in stable condition and she is on follow up till date.

Conclusion :

Management of corrosive stricture warrants expertise and dilatation has to be done very carefully. Surgery remains the mainstay in situations where the stricture is undilatable or warrants frequent dilatations. Diligent management of perforation during dilatation is very important. This is presented for successful management of a complex situation in a child.