Esophageal placement of a biliary stent to manage a iatrogenic esophageal perforation: A case report

Introduction

Post-operative anastomotic stricture can occur after a gastric tube esophagoplasty in children with esophageal atresia, resulting in difficulty swallowing. Endoscopic dilatation is commonly used to treat these strictures. The dilatations carry a risk of esophageal perforation.

Case presentation

A two-year-old male was admitted to the intensive care unit for an esophageal perforation that resulted from an esophageal dilatation. He had a history of long-gap type-C esophageal atresia/tracheo-esophageal, which had been managed with a cervical esophagostomy and a gastrostomy at birth, followed by an esophageal replacement by reverse gastric tube at the age of 17 months. At the age of 20 months, he developed dysphagia. An esophageal stricture was diagnosed by endoscopy. He underwent several balloon dilatations, followed by dilatations with solid dilators. The last dilatation was complicated by the esophageal perforation that prompted his hospital admission. At the time of the admission, we placed a chest tube, started antibiotics, and kept him NPO. We resumed enteral feedings 12 days after the perforation but immediately noticed that the formula was draining out of the chest tube. A surgical repair of the persistent fistula was deemed unsafe. We decided to place a biliary stent to cover the perforation endoscopically. Nasogastric feeds were reinitiated. The stent was kept in place for six weeks, while the patient was fed by a nasogastric tube. After 6 weeks, a contrast study confirmed that the perforation had sealed. Oral feedings were started at that time and the chest tube was removed. He has had no recurrence of the perforation or the stricture since then.

Conclusion

Biliary stents could be an option for the management of iatrogenic esophageal perforations in children.