Treatment of a 5-year-old child with damage to the esophagus: a case report

Abstract

Diagnosis and treatment of esophageal injuries remain the most difficult problems in pediatric urgent surgery with high mortality rates. Restoration of function in severe multiple-organ disorders associated with the development of mediastinitis and sepsis in children requires a multidisciplinary approach and the search for alternative treatment methods that help close the esophageal defect and prevent inflammation. These methods include a constant negative pressure system.

Severe polytrauma led to the development of local inflammation and mediastinitis. The formed esophageal fistula with clinical sepsis required multistage surgical treatment and support of several specialists. At the Regional Children’s Clinical Hospital No. 1 in Vladivostok, at the first stage of treatment, the mediastinum and soft tissues of the neck were drained, which made it possible to stop the spread of inflammation and stabilize the patient’s condition. The effectiveness of the second stage of surgical treatment using the VAC system was noted in the first 48 h, in the form of a significant reduction in local inflammation and elimination of skin maceration. The VAC system provided adequate drainage of the wound cavity and promoted wound cleansing and growth of granulation tissue. Dissociation of the fistula by applying a gastrostomy made it possible to create favorable conditions for the healing of the esophageal defect and ensure adequate enteral nutrition for the patient.

Damage to the esophagus with the development of mediastinitis and sepsis are critical conditions; therefore, treatment outcomes depend on early diagnosis and timely surgical treatment. A full-fledged surgical treatment in a specialized hospital helps eliminate complications of damage to effectively restore functions and lead to patient recovery.

Keywords

esophageal injury / mediastinitis / fistula / pediatric surgery

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Belov S.A., Cyleva Y.I., Grigoryuk A.A.