Esophageal Perforation

Esophageal perforations are rare in children, but the incidence is increasing as more diagnostic and therapeutic endoscopies are performed. Iatrogenic esophageal perforation is the cause in 33%-75% of cases (MARtiNEz et al. 2003). The incidence is low in upper endoscopy, and higher with rigid dilators. Esophageal perforations are more likely to occur if a foreign body has been present more than 24 h and caused pressure necrosis. Other etiologies are pill-induced, caustic damage, infectious, including candida, herpes and tuberculosis. Cervical esopha-geal perforation may result from penetrating trauma by objects in the mouth, including lollipops and pencils. Esophageal perforation is potentially life-threatening because it allows entry of bacteria and digestive enzymes into the pleural and subphrenic spaces and the mediastinum, causing sepsis. Perforation of the intraabdominal esophagus may lead to sepsis and shock.

Conservative non-operative therapy for esopha-geal perforation is preferred. In children this consists of antibiotic coverage, drainage of pleural effusions, esophageal rest and total parenteral nutrition if there is no evidence of contrast leak at esophagram. Successful outcome depends on early diagnosis and treatment, young age and absence of underlying disease (MARtiNEz et al. 2003). Operative treatment may be required with esophageal perforation or gross leakage.

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