Oesophageal Perforation during Chemoradiation for Ewing’s Sarcoma: A Case Report

Oesophageal Perforation (EP) is a rare condition, mostly iatrogenic, commonly caused by endoscopic procedures. Non-iatrogenic EP associated with chemoradiotherapy for non-oesophagal malignancies is exceedingly rare. We report a case of oesophageal perforation in an eight-year-old girl undergoing adjuvant chemoradiotherapy for posterior fossa Ewing’s sarcoma. During intensive chemotherapy, the patient developed acute chest pain, recurrent vomiting and abdominal pain. Diagnostic evaluation via gastrografin swallow X-ray confirmed an oesophageal perforation. The child was initially managed with a gastrostomy tube for enteral feeding, followed by posterolateral thoracotomy and repair of EP. The patient had an uneventful postoperative recovery. This case highlights the need for high clinical vigilance in paediatric oncology patients undergoing intensive chemotherapeutic regimens, where atypical presentations of gastrointestinal complications may arise. Early recognition and multidisciplinary interventions are essential to mitigate the risks of EP and optimise outcomes in this vulnerable population.