ESOPHAGEAL REPLACEMENT IN CHILDREN WHO HAVE CAUSTIC PHARYNGOESOPHAGEAL STRICTURES

Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx, and esophagus is a challenging reconstructive pr oblem. The authors report on seven patients who required total esophag eal replacement from the pharynx to the stomach, Injury occurred from alkali in six and acid in one. Age at injury ranged from 14 months to 14 years (mean, 4.5 years.) in five boys and two girls, Time from inju ry to esophageal replacement was 6 months to 10 years (mean, 3.5 years ). Two required pharyngeal reconstruction before and one after esophag eal replacement. Six patients had an isoperistaltic right or transvers e colon interposition. One who had gastric necrosis had an ileo-right colonic substernal interposition with creation of a jejunal reservoir. Results of barium swallows showed intact anastomoses in all patients. There were no leaks. Most had some degree of mild to moderate aspirat ion, and one who had left vocal cord paralysis had initially massive a spiration. Three patients currently eat regular diets; four eat but st ill require supplemental tube feeds. The authors conclude that childre n who have hypopharyngeal scarring and obliterated esophageal inlet ca n undergo a successful colonic esophageal replacement with high proxim al pharyngocolic anastomosis. Copyright (C) 1997 by W.B. Saunders Comp any.