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TÜRKÇE
Poster - 55
Unusual Presentation of Esophageal perforation Following Esophageal Elongation procedure: A Case Study
N Almefleh
idlib university hospital, medicine college
Introduction
Esophageal dilation is frequently performed as after E.A or corrosive strictures. The standard procedure involves a balloon or a bougie dilation by endoscopy under flouroscopy. However, this approach can lead to some complications. here we present a rare complication with unusual presentation.
Case Presentation:
A 3-year-old girl with a gastrostomy and cervical esophagostomy due to long-gap E.A. She underwent thoracoscopic proximal esophageal elongation using the Kimura technique, alongside distal esophageal lengthening via the Foker technique. An esophageal anastomosis was performed through thoracotomy. Following the procedure, the child remained on a ventilator for 21 days before successful weaning. NGT was in place for 1.5 months post-surgery. A barium swallow confirmed no stenosis or fistula, and the child was able to feed without complications for six weeks. Subsequently, symptoms refer to esophageal stenosis. During an endoscopy, significant stenosis was identified, guide wire position was confirmed at stomach level using fluoroscopy. After hours of 9 mm bougei dilation was done, the patient reported abdominal pain. X-ray revealed free air (4) in the abdomen but no effusion. Upon laparotomy at another facility, no perforation was detected; however, a bruise was noted on the greater curvature near the fundus. The patient was admitted for a weekwith icreasing free air in the abdomen, leading to another laparotomy. This time, damage was identified below and medial to the esophagus, where the wire had penetrated through the esophageal wall into the abdominal cavity. TAT was placed through the esophagus to bypass the injury and extended to the pylorus for feeding. After one week of recovery and plans for discharge, the child developed severe bronchospasm requiring ventilatory support but did not respond to treatment. Tragically, she dead within 24 hours, with suspected bronchospasm attributed to a drug allergy.
Conclusion:
Esophageal surgeries modify normal anatomy, increasing risks during subsequent dilation procedures. Perforation is a critical complication where a guide wire may inadvertently enter pre-existing holes in the esophagus. Dilation under these circumstances can worsen existing perforations, leading to severe complications like mediastinitis or leakage into surrounding tissues. So it is important to be aware in the specially cases that is beginning to increase with development this surgery