Liu Meng-Chuan, Wang Yao-Sheng, Yang Yao-Jong, Lai Fu-Ping
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Front Pediatr. 2020 Oct 28;8:545760. doi: 10.3389/fped.2020.545760. eCollection 2020.
Esophageal perforation is a rare but critical emergency that requires early detection and prompt management. In the pediatric population, iatrogenic injury is the most common etiology of esophageal perforation, and the majority of cases come from stricture dilation. Treatment options include medical management, endoscopic therapy, and surgery. Usually, conservative treatment is appropriate in most carefully selected patients, especially in the setting of early diagnosis and with the absence of severe sepsis. A surgical approach is reserved for a large tear with mediastinum contamination, or clinical deterioration after unsuccessful conservative management. With the advancement of the endoscopy technique, endoscopy therapy using esophageal stents is an available choice for adult populations who have a complicated protracted healing course or comorbidities precluding surgical attempts. However, this procedure is seldom implemented in children, especially in young infants, owing to unavailable equipment and experts. We report our successful use of a fully-covered self-expandable metal biliary stent in managing esophageal perforation in a seven-month-old infant. In light of this encouraging achievement, this model can be applied to more children who have the same problem.
食管穿孔是一种罕见但严重的急症，需要早期发现并迅速处理。在儿科人群中，医源性损伤是食管穿孔最常见的病因，大多数病例源于狭窄扩张。治疗选择包括药物治疗、内镜治疗和手术。通常，在大多数经过精心挑选的患者中，保守治疗是合适的，尤其是在早期诊断且无严重脓毒症的情况下。手术方法适用于伴有纵隔污染的大撕裂伤，或保守治疗失败后的临床恶化情况。随着内镜技术的进步，对于愈合过程复杂或有合并症而无法进行手术的成年患者，使用食管支架的内镜治疗是一种可行的选择。然而，由于设备和专家资源有限，该手术在儿童中很少实施，尤其是在幼儿中。我们报告了成功使用全覆膜自膨式金属胆道支架治疗一名7个月大婴儿食管穿孔的案例。鉴于这一令人鼓舞的成果，该模式可应用于更多有相同问题的儿童。
