Delayed presentation of iatrogenic esophageal perforation in children: A case series

Esophageal perforation is a rare condition in children. It can be fatal and its mortality increases if the diagnosis is delayed. We report three pediatric cases of delayed presentation of esophageal perforation, all linked to an iatrogenic cause. Case 1 was a 3-year-old female child who had tachycardia, tachypnea and subcutaneous emphysema two days following a diagnostic endoscopy. She underwent an esophagram that showed a major leak in the mid esophagus. We placed a chest tube and did a surgical jejunostomy for enteral feedings. The perforation healed completely and spontaneously by day 23 of admission, as confirmed by a contrast study. Case 2 was an 11-year-old boy who had chest pain, dyspnea, fever, mild abdominal tenderness, and subcutaneous emphysema three days after undergoing an unsuccessful endoscopy to retrieve swallowed foreign bodies (2 coins). A barium swallow revealed a major leak in the lower third of the esophagus and plain chest fluoroscopy showed the coins in the pleural space. We did a thoracotomy, pleural wash-out, retrieval of the foreign bodies, and left a chest tube in place. The patient required an exploratory laparotomy and repair of a duodenal perforation of unknown etiology. At that time, we also did a gastrostomy and a jejunostomy. The perforation healed spontaneously, with a tiny leak remaining by day 50. Case 3 was a 4-year-old boy who developed a perforation of the lower third of the esophagus following an endoscopic balloon dilatation of an esophageal stricture. We placed a chest tube and did a gastrostomy and a feeding jejunostomy. The esophageal perforation had closed spontaneously by day 55. The three patients survived and still have their native esophagus. Esophageal perforations that present beyond the first 24 hours may be managed with conservative measurements, without a surgical esophageal repair.