Caustic ingestion and oesophageal damage in children: Clinical spectrum and feeding practices.

AIM: The study aims to evaluate the association of oesophageal damage with clinical data and feeding practices in children who suffered a caustic substance ingestion (CSI). METHODS: Cross-sectional design was used in this study. The setting was at a paediatric referral hospital in 2006. Ninety-four children with CSI were used as study samples, with mean age of 38.4 months, and 37.2% were females. The independent variable was oesophageal damage; the dependent variables were clinical data and feeding practices. RESULTS: Main symptoms included salivation, oropharyngeal burns and vomiting. On endoscopy, 84.6% had second- or third-degree burns. Oesophageal stricture occurred in 48.9%. Severe burns were associated with oesophageal stricture and ingestion of alkaline products; dysphagia was associated with oesophageal stricture. In about one fourth of the cases, a nutritional intervention with complete and balanced liquid diets was required to maintain the adequate daily recommended intake (DRI). CONCLUSIONS: Alkali ingestion was associated with severe burns and oesophageal stricture. The presence of oesophageal strictures and dysphagia required changes in the feeding practices in order to maintain an adequate nutritional status and/or to complete their DRI.

Role of fibrin glue in the prevention of cervical leakage and strictures after esophageal reconstruction of caustic injury.

BACKGROUND: The colon is the organ most commonly used for esophageal reconstruction after severe caustic injury. Complications of cervical anastomosis are very common. Fibrin sealant may reduce the incidence of complications in this high-risk anastomosis. The purpose of the present study was to assess the role of fibrin glue in the prevention of leakage and stricture at cervical coloesophageal anastomoses in children treated with esophageal reconstruction after caustic injury. METHODS: This was a case-control study of children with caustic esophageal injury treated surgically with esophageal reconstruction over a 10-year period. In the study group 3-4 ml of fibrin glue was placed over the anastomosis. The following variables were assessed: age, sex, weight, leakage or stricture at the cervical anastomosis, morbidity, and mortality. RESULTS: The study group included 14 children, and the control group included 24 children. There were no differences in the distributions of sex, age, anthropometric variables, or preoperative laboratory test results. All children underwent esophageal replacement with colon substitution through the retrosternal space. Dehiscence and leakage at the cervical anastomosis were observed in 50% of children in the control group and 28.5% of children in the study group (P = 0.17). Strictures were observed in 7.15% of the study group and 20.8% of the control group, and 5 and 17 children, respectively, developed cervical complications (P = 0.03). There were no differences in major complications, and mortality was similar in the two groups (P = 0.60). CONCLUSIONS: Fibrin glue, when used as a sealant for cervical coloesophageal anastomosis, can reduce the risk of leakage and stricture.

[Cervical esophagogastrostomy dehiscence after gastric pull-up for type I esophageal atresia. Case report of a patient successfully treated with fibrin glue and a review of the literature]. / Dehiscencia de esófago-gastroanastomosis cervical posterior a ascenso gástrico por atresia esofágica tipo I. Reporte de un caso exitoso tratado con gel de fibrina y revisión de literatura.

INTRODUCTION: The treatment of choice for type 1 esophageal atresia is surgery to re-establish continuity of gastrointestinal tract by colon interposition or gastric pull-up. Incidence of cervical anastomosis dehiscence is 20-40%. Although it is not a serious complication, it requires a fasting period and nutritional support to achieve spontaneous closure within 2-4 weeks. AIM: To report successful treatment of cervical esophageal-gastric anastomosis dehiscence after gastric transposition using fibrin glue. CASE PRESENTATION: A 17-month-old female child, the product of a first pregnancy, was delivered by caesarean section at 35 weeks gestation in response to fetal distress; the child weighed 1,800 g at birth and had APGAR score of 6-8. At 7 h of extra-uterine life, she was diagnosed with type I esophageal atresia and cervical esophagostomy was performed. Stamm-type gastrostomy was used for enteral nutrition until she was 17 months of age. With a weight of 9 kg, the child underwent esophageal substitution with transhiatal gastric transposition, cervical anastomosis, and jejunostomy. On the seventh day postsurgery, surgical wound infection was observed, producing purulent material and saliva (45 ml in 24 h). On the 10th day, esophagogram was performed that revealed 30% anastomosis dehiscence and 2-cm fistulous tract with no abscess. On the 11th day, 3 ml of fibrinogen (80 mg/mL) activated with thrombin (1,000 uL/mL), both of human extraction (Quixil, Omrix, Tel Aviv, Israel) was applied through fistula tract. RESULT: The following day, the patient presented with cough access, expelling the fibrin glue plug. A similar dose was given that achieved a null output volume during the following 24 h. Subsequently, she began oral feeding with liquids, incorporating a normal diet over the following 2 months. At present, she is 3 years 2 months of age, weighs 15 kg, and is able to eat any kind of food without dysphagia. CONCLUSIONS: We demonstrated that use of biological adhesives can shorten time required to achieve closure of high- and low-output volume fistulas. In the present case, use of fibrin glue to obliterate the fistulous tract gave satisfactory results, reducing time to spontaneous closure and facilitating early commencement of oral feeding. Cases of enterocutaneous fistula closure reviewed in the literatura generally involve adults, but the technique can be used in children with this type of complication.