Surgical treatment of acquired tracheoesophageal fistula caused by balloon dilatation of corrosive esophageal stricture in a child

Dejan Stojakov; Maja Miličković; Predrag Minić; Miroslav Vukadin; Nikola Stanković; Djordje Savić

doi:10.2298/VSP180615169S

Dejan Stojakov Clinical Center of Serbia, First Surgical University Hospital, Clinic for Digestive Surgery Department of Esophagogastric Surgery, Belgrade, Serbia
Maja Miličković University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Predrag Minić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Miroslav Vukadin Mother and Child Health Care Institute of Serbia “Dr. Vukan Čupić”, Department of Abdominal Surgery, Belgrade, Serbia
Nikola Stanković University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Djordje Savić University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180615169S

Keywords: esophageal stenosis, burns, chemicals, dilatation, tracheoesophageal fistula, digestive system surgical procedures, child preschool, treatment outcome

Abstract

Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the treatment of TEF caused by balloon dilatation of corrosive esophageal stricture in children.

References

Eliçevik M, Alim A, Tekant GT, Sarimurat N, Adaletli I, Ku-rugoglu S, et al. Management of esophageal perforation second-ary to caustic esophageal injury in children. Surg Today 2008; 38(4): 311‒5.

Panieri E, Millar AJ, Rode H, Brown RA, Cywes S. Iatrogenic esophageal perforation in children: patterns of injury, presen-tation, management, and outcome. J Pediatr Surg 1996; 31(7): 890‒5.

Mutaf O, Avanoglu A, Mevsim A, Özok G. Management of tra-cheoesophageal fistula as a complication of esophageal dilata-tions in caustic esophageal burns. J Pediatr Surg 1995; 30(6): 823‒6.

Avanoğlu A, Ergün O, Mutaf O. Management of instrumental perforation of the esophagus occurring during treatment of corrosive strictures. J Pediatr Surg 1998; 33(9): 1393‒5.

Yalçin Ş, Ciftci AO, Karnak I, Tanyel FC, Şenocak ME. Manage-ment of acquired tracheoesophageal fistula with various clini-cal presentations. J Pediatr Surg 2011; 46(10): 1887‒92.

Freire JP, Mendes de Almeida JC. Review of (acquired) inci-dental, rare and difficult tracheoesophageal fistula manage-ment. World J Surg Proced 2014; 4(1): 9‒12.

Ng J, Antao B, Bartram J, Raghavan A, Shawis R. Diagnostic dif-ficulties in the management of H-type tracheoesophageal fis-tula. Acta Radiol 2006; 47(8): 801‒5.

Imamoğlu M, Cay A, Koşucu P, Ahmetoğlu A, Sarihan H. Ac-quired tracheo-esophageal fistulas caused by button battery lodged in the esophagus. Pediatr Surg Int 2004; 20(4): 292‒4.

Crema E, Fatureto MC, Gonzaga MN, Pastore R, da Silva AA. Tracheoesophageal fistula after caustic ingestion. J Bras Pneumol 2007; 33(1): 105‒8. (English, Portuguese)

Radovanović N, Simić A, Kotarac M, StojakovD, Sabljak P, Skrobić O, et al. Colon interposition for pharyngoesophageal postcor-rosive strictures. Hepatogastroenterology 2009; 56(89): 139‒43.