WOFAPS 2025 8th World Congress of Pediatric Surgery

Charulata Devidas Naik, Archana Puri

VMMC and Safdarjang Hospital, New Delhi

Introduction : Pediatric distal esophageal perforation has high morbidity and its management depends on prompt diagnosis , patient’s hemodynamic stability and nutritional status .

Methods : Through four patients of distal esophageal perforations ,this study highlights its varied aetiology and management options.

Results : Four cases were observed - a 7 year old with caustic ingestion , 8 year old with penetrating trauma , 11 year old with iatrogenic trauma and 25 day old child with hiatal hernia induced ischemia. The older children had perforations at 2-3 cm from gastroesophageal junction(GEJ) and in neonate at GEJ itself. In the first case, the child developed pneumothorax post caustic ingestion requiring intercostal drainage(ICD) .The patient also underwent delayed failed Video Assisted Thoracic Surgery. The second child had lower thoracoabdominal trauma ,for which a negative laparotomy with ICD insertion was done. On feed extravasation ,Self Expanding Metallic Stent placement and a feeding jejunostomy was done. The stent however migrated into the stomach. The third child had empyema for which repeated ICD insertions were done followed by food extravasation through it . All patients presented to our institute with malnutrition and empyema ,initially managed with total parenteral nutrition and ICD drainage. To avoid chest adhesions , laparotomy with hiatal exploration was done with creation of gastrostomy and feeding jejunostomy. Fundoplication was also done in the first child. Postoperatively , all three patients had decreased ICD leaks and were afebrile with positive weight gain. The fourth case involved a neonate undergoing surgery for hiatal hernia where an ischemic perforation at GEJ was found and repaired , followed by uneventful initiation of feeds on postoperative day 5 .

Conclusion :Delayed diagnosis of esophageal perforations impacts the nutritional status of the patient. In infected cases, establishing distal feeding and performing fundoplication are crucial to prevent gastric reflux and further nutritional decline. Multidisciplinary approaches involving surgical interventions and nutritional support are essential for successful outcomes and patient recovery.