Acquired strictures in children are most commonly encountered after surgical repair of EA and TEF. Strictures in the pediatric population may be caused by caustic ingestion, esophagitis and epidermolysis bullosa. Symptoms vary with the degree of tightness of the stricture, and include dyspha-gia, chest pain, cough and vomiting of undigested 126.96.36.199 food. Drooling and refusal to eat may be signs of a Radiological Findings foreign body causing complete obstruction of the stricture. The chest radiograph is usually normal. Occasion-
Balloon dilatation is the preferred treatment ally, an esophageal air-fluid level can be seen above above traditional bougienage, and surgery is rarely an esophageal obstruction. Barium esophagram, the indicated. modality of choice, demonstrates strictures as nar-
Fig. 2.27. Colonic interposition. Treatment for a high-grade long segment caustic stricture
Fig. 2.27. Colonic interposition. Treatment for a high-grade long segment caustic stricture rowing of the esophageal lumen and lack of disten-sibility which may be localized or diffuse (Fig. 2.28) (KARAsiCK and LEv-ToAff 1995). The radiological appearance varies with the type of stricture and its caliber.
Fluoroscopic dilatation has many advantages over bougienage because balloon dilatation is not limited by the diameter of the nose or pharynx, and the incidence of perforation with balloon dilatation is much lower than with bougie dilatation (FAsulAKis and ANDR0NiK0u 2003). Serial balloon dilatation is recommended because progressive stretching of scar tissue prevents tears and perforations. Scar tissue can limit success since fibrosis and altered blood supply reduce tissue elasticity (FAsulAKis and ANDR0NiK0u 2003). The balloon is inflated under fluoroscopy at the level of the stricture, applying uniform radial force that is less traumatic than the shearing force of bougienage. Fluoroscopy has the added advantage of allowing the radiologist to check that the stricture is dilated to a suitable diameter. After dilatation, the success of the procedure can be monitored immediately with the introduction of water soluble contrast medium to show an increase in esophageal caliber and to evaluate for a leak or perforation (FAsulAKis and ANDR0NiK0u 2003).
Fig. 2.28. Esophageal stricture. Barium swallow shows a long stricture involving almost the entire length of the esophagus years after ingesting an unknown corrosive agent
Although strictures may not be completely resolved after balloon dilatation, the procedure will provide functional relief, often further aided by forceful swallowing by the patient (AllmENDiNgER et al. 1996). Balloon dilatation has to be repeated as the child grows (AllmENDiNgER et al. 1996). Ongoing and progressive diseases such as repaired esophageal atresia and epidermolysis bullosa require repeated dilatation as the disease progresses (Fig. 2.29).
Was this article helpful?