RESUMEN
Introducción. La ingestión de cuerpo extraño (CE) es frecuente observarla en la consulta pediátrica; aunque el mayor porcentaje son monedas, la ingestión de pilas de disco o botón son un problema serio. Objetivos: conocer las principales lesiones esofágicas ocasionadas por la ingesta de pilas de disco (IPD), así como la respuesta al manejo y su evolución. Métodos. En un estudio retrospectivo, donde se revisaron los expedientes de pacientes con diagnóstico de IPD de diciembre 1996 a 2007, se analizó: sexo, edad, síntomas, tiempo de evolución, hallazgos radiológicos y endoscópicos, manejo, complicaciones y secuelas. Resultados. Se encontraron 21 casos de IPD; predominó el sexo masculino en relación 4:1, con edades de 3 meses a 12 años. El síntoma principal fue sialorrea. El tiempo de evolución fue en promedio de 39.6 horas. En 14 pacientes la extracción del CE se realizó con laringoscopio tipo Jackson, con esofagoscopio rígido en 2 y con panendoscopio en 4, y en 1 se utilizó red de recuperación de Roth. La mayoría de los CE estaban alojados en el tercio superior de esófago. A la endoscopia se encontraron úlceras en 8 pacientes, necrosis en 6, úlcera y necrosis en 1, perforación parcial en 1, perforación con fístula traqueoesofágica en 2, y en 3 pacientes no hubo evidencia de lesión. Sólo 5 pacientes evolucionaron a estenosis esofágica, que se resolvió con dilataciones. Dos pacientes con perforación y fístula traqueoesofágica recibieron manejo quirúrgico, falleciendo uno de ellos. Otro paciente con perforación solicitó alta voluntaria. Conclusiones. La IPD es cada vez más frecuente, su extracción en el esófago debe ser urgente para evitar complicaciones graves como la estenosis y fístula traqueoesofágica.
Introduction. Foreign body ingestion is a common cause of consultation in the pediatric practice. Even though the most frequent ingested objects are coins, the button disk batteries are becoming a serious problem. Objectives: To describe the main esophageal lesions caused by the ingestion of button disk batteries, their response to treatment and clinical evolution. Methods. Files from patients admitted to our hospital with diagnosis of button disk battery ingestion between December 1996 to December 2007 were reviewed. We analyzed sex, age, symptoms, evolution time, radiological and endoscopical findings, management, complications and long term sequels. Results. We found 21 cases, male preponderance 4:1, age rank from 3 months to 12 years. Sialorrhea was the main symptom. Average time to treatment was 39.6 hours. Battery removal was accomplished with direct esophagoscopy using Jackson laryngoscope in 14 patients, rigid esophagoscope in 2 patients, and flexible esophagoscopy in 4. In most of the cases the battery was lodged in the proximal third of the esophagus. At endoscopic exploration, esophageal ulcers were found in 8 patients, necrosis in 6, ulcers and necrosis in 1, partial perforation in 1, perforation with traqueoesophageal fistula in 2, and no injury in 3 patients. Only 5 patients evolved to esophageal stenosis that resolved with dilatations. Two patients with perforation and traqueoesophageal fistula underwent surgical treatment, one of them died. Another patient with perforation was lost to follow up because of voluntary discharge. Conclusions. Button disk battery ingestion is becoming a more frequent event; removal from the esophagus should be an urgent procedure to avoid severe complications such as stenosis and traqueoesophageal fistula.
RESUMEN
A atresia é a má-formação congênita mais comum do esôfago. A evolução é o sucesso na correção cirúrgica da atresia de esõfago constitui o principal marco para o reconhecimento e estabecimento da cirúrgia pediátrica como especialidade.Desde a sua primeira descrição por Durston,em 1670, a atresia de esôfago experimentou um avanço significativo em seu tratamento, passando de uma mortalidade de 100% para uma sobrevida atual de 60 a 90% nos centros de referência.Os bons resultados em seu tratamento decorrem da tecnica da equipe cirúrgica e infra-estrutura hospitar adequada.Em Juiz de Fora e região não há , até a presente data, relato de estudos de pacientes conduzidos e operados de atresia de esôfago parametrando os resultados e comparando-os com os referenciais da literatura.O objetivo deste estudo retrospectivo é apresentar a casuítica de 28 pacientes portadores de atresia de esôfago, operados no período de fevereiro/1994 a outubro /2001.Para tanto,dividimos a casuítica em 2 fases iguais,contendo,cada uma ,14 pacientes e duração de 4 anos.Analisando a sobrevida obtida em cada fase, obtivemos indices de 28,5% na fase inicial e de 85,7% na fase subquente.Tal ocorrência reflete a melhoria na assistência prestada,operação mais precoce,bem como o aprimoramento técnico-profissional e institucional, ocorrido na 2ª fase.
Atresia is the most common congenital malformation of the esophageal. Sucess and evolution in the surgical correction of esophageal atresia is considerd to be the main hallmark to the acknowledgement of pediatric surgery as a speciality. since its firts description by Durston, in 1670,esophageal atresia treatment has experienced substantial advance, rising from a mortartaly rate of 100% to a survival rate of 60 a 90% in the best treatment centers.Good results in its treatment are obtained from harmonious relationships among early diagnosis, technical ability of the surgical team and adequate infrastructure in hospitals. Until the present date, there is not any registered study of operated patients with esophageal atresia in Juiz de Fora and surroundings analyzing and comparing results with references in the current literature. The aim of this retrospective study is to present our experience involving 28 patients we have o perated on between February/1994 and October/2001.To do so, we have divided our patients into 2 equal groups, each containing 14 patients and lasting 4years.By analyzing the survival rate obtained in each group,we have come to the following result:28.5% in the first group and 85.7% in the second.Such a fact shows improvement in the assistance we have provided, earlier surgery, as well as technical mastering and institutional development, which took place in the second analysed period.