67 T-TUBE FISTULISATION OF OESOPHAGEAL PERFORATIONS
Elizabeth Gavens, Mike Thompson, Richard Lindley, Sean Marven
Sheffield Childrens Hospital, Sheffield, United Kingdom

Abstract

Aim

Large oesophageal perforations are thankfully rare in the paediatric population but can be difficult to treat. We share our experience of 3 patients successfully managed with oesophageal t-tube placement.

 

Methods

Retrospective case series of 3 paediatric patients with large oesophageal perforations and significant oesophageal leaks managed with T tube placement.

 

Results

2 of our patients had oesophageal perforations due to button battery ingestion and 1 patient following flexible oesophagoscopy and dilatation (summarised Table1). After button battery removal both patients developed respiratory distress and chest x-ray showed a hydropneumothorax. The first child went straight for a thoracotomy and t-tube insertion on day of diagnosis. The second child was initially managed with a chest drain and oesophageal stent, but ongoing oesophageal leak lead to thoracotomy, insertion of T-Tube and serratus anterior muscle flap on day 10. 

Our third patient was born at 32+1 with long gap oesophageal atresia and trache-oesophageal fistula. 9 hours after her third oesophagoscopy and balloon dilatation she developed increased respiratory effort. She was diagnosed with an aspiration pneumonia but 3 days later repeat chest XRay showed a large pleural effusion. A chest drain was inserted and continued to drain large volume, thick secretions, so on day 8 she underwent a thoracoscopic placement of T-Tube.

Once output from the drains reduced, all patients underwent endoscopy, t-tube removal and application of fibrin glue. All patients are now orally feeding, without any evidence of stricture.



Conclusion

There are a number of adult case reports and we have previously reported one paediatric patient. We were disappointed with the failure of a covered oesophageal stent for button battery perforation. We believe t-tubes should be considered as the first line of management for difficult or persistent oesophageal perforations. Synchronous thoracoscopic and endoscopic insertion of oesophageal t-tube is possible.


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