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