Esophageal caustic injuries and colon interposition in children: Long-term follow-up

Background : As sodium hydroxide (NaOH) is frequently used as a cleaning agent for air conditioners in southern Iran, caustic esophageal injuries happen frequently especially in children. After undergoing several dilatation procedures of the esophagus, a number of these patients eventually require colon interposition, an operation by which the esophagus is replaced by a segment of colon. Colon interposition is a surgical treatment modality for patients with severe caustic injuries in the esophagus. This study describes the technique and results of colon interposition in patients who had undergone this operation. Materials and Methods : All patients who underwent colon interposition in Nemazee Hospital affiliated to Shiraz University of Medical Sciences in southern Iran from April 1990 to April 2005, were enrolled in our study. Medical records of these patients were reviewed and they were called for a follow-up examination. Out of 18 patients, only eight patients responded. They underwent clinical examination, laboratory tests, imaging and endoscopy. Results : Growth retardation was seen in all cases. All radiographs of the chest revealed peribronchial thickening. Redundancy was seen in 60% of the patients. Lower junction stenosis, diverticulum and dilatation of the esophagus were commonly visible. Epigastric fullness (85%), dysphagia (57%), halitosis (45%), heartburn (45%), vomiting (45%), odynophagia (28%) and abdominal pain (28%) were the most common complications. There were no mortalities in our series. Conclusions : As growth retardation was the most common complication of colon interposition in children, an appropriate nutritional support seems to be necessary after the operation

Esophageal caustic injuries and colon interposition in children: Long-term follow-up

Background : As sodium hydroxide (NaOH) is frequently used as a cleaning agent for air conditioners in southern Iran, caustic esophageal injuries happen frequently especially in children. After undergoing several dilatation procedures of the esophagus, a number of these patients eventually require colon interposition, an operation by which the esophagus is replaced by a segment of colon. Colon interposition is a surgical treatment modality for patients with severe caustic injuries in the esophagus. This study describes the technique and results of colon interposition in patients who had undergone this operation. Materials and Methods : All patients who underwent colon interposition in Nemazee Hospital affiliated to Shiraz University of Medical Sciences in southern Iran from April 1990 to April 2005, were enrolled in our study. Medical records of these patients were reviewed and they were called for a follow-up examination. Out of 18 patients, only eight patients responded. They underwent clinical examination, laboratory tests, imaging and endoscopy. Results : Growth retardation was seen in all cases. All radiographs of the chest revealed peribronchial thickening. Redundancy was seen in 60% of the patients. Lower junction stenosis, diverticulum and dilatation of the esophagus were commonly visible. Epigastric fullness (85%), dysphagia (57%), halitosis (45%), heartburn (45%), vomiting (45%), odynophagia (28%) and abdominal pain (28%) were the most common complications. There were no mortalities in our series. Conclusions : As growth retardation was the most common complication of colon interposition in children, an appropriate nutritional support seems to be necessary after the operation

The role of gastrostomy in the staged operation of esophageal atresia

Introduction: The aim of this study is to recommend criteria for selection of patients who benefited from the use of gastrostomy rather than emergency fistula closure during the staged operation of esophageal atresia (EA). Materials and Methods: Between August 2004 and July 2006, 75 cases of EA, were consecutively operated. Nineteen out of 75 (25%) underwent routine gastrostomy because they required a type of staged operation: Group I: Five cases with pure atresia had gastrostomy and esophagostomy; Group II: Six with severe pneumonia and congenital heart disease (Waterson class C) had gastrostomy and conservative management; Group III: Eight with long gap EA (2-4 vertebras); four out of 8 cases underwent primary anastomosis with tension and the other four had delayed primary anastomosis plus primary gastrostomy. Results: GI: Only three cases survived after esophageal substitution; GII: Three out of six cases with severe pneumonia (fistula size: f > 2.5 mm) underwent emergency fistula closure with only one survival, but all (f < 2.5 mm) recovered without complication, GIII: Four patients with long gap and primary anastomosis with tension developed anastomotic leakage; they required gastrostomy following the leakage, except for those with delayed primary anastomosis, and all of them recovered without early complications. Conclusion : All the cases with long gap, although two esophageal ends can be reached with tension, should undergo delayed primary closure with primary gastrostomy. Those were brought with Waterson class C and the fistula size greater than 2.5 mm should undergo emergency fistula closure; however, if fistula size was less than 2.5 mm, it is better to be delayed by primary gastrostomy for stabilization. In this study, we had a better outcome with gastric tube for substitution than colon interposition in infants