WOFAPS 2025 8th World Congress of Pediatric Surgery

Ruijie Zhou, Long Li, Chihuan Kong

Department of General Surgery, Capital Center for Children's Health, Capital Medical University, Beijing, China

Introduction

To explore the safety and efficacy of endoscopic examination and treatment of esophageal submucosal abscess.

Case Reports

Case 1, an 11-year-old boy, was admitted to our hospital with fever and sore throat for more than a week and progressive dyspnea for more than a day. He had suspicious history of esophageal foreign body incarceration. Hematological investigations showed abnormally high white blood cell count and C-reactive protein levels. Contrast-enhanced computed tomography showed a low-density area with enhancement in the mediastinum, especially around the esophageal wall. Endoscopy was performed that revealed a laceration in the esophageal mucosa 14 cm from the incisors. No foreign bodies were detected in the esophagus. Considering the large abscess cavity, it was drained by endoscopic mucosal incision and a negative-pressure drainage tube. The tracheal intubation was removed on the 1st day after operation. The drainage tube in the abscess cavity was removed on postoperative day 20, and oral feeding resumed on postoperative day 23.

Case 2, a 7-year-old boy, was admitted to our hospital because of intermittent fever for 8 days and labored breathing for 2 days. He did not remember swallowing a foreign body. Hematological investigations showed similar changes to case1. Enhanced CT demonstrated suspected double-barreled esophagus sign. Esophagography revealed that water soluble contrast agent reached the mediastinum without no diffusion. Endoscopy revealed a laceration in the lower esophageal mucosa and no foreign bodies. The submucosal abscess was drained by endoscopic mucosal incision. Oral intake was started on postoperative day 2.

Both patients were discharged without any complications.

Conclusion

It is relatively difficult to diagnose esophageal submucosal abscess, but the symptoms are dangerous and develop rapidly. Endoscopic examination facilitates timely diagnosis and intervention. Endoscopic mucosal incision combined with drainage of abscess cavity is feasible and less-invasive for the treatment.