Rs. Choi et al., ESOPHAGEAL REPLACEMENT IN CHILDREN WHO HAVE CAUSTIC PHARYNGOESOPHAGEAL STRICTURES, Journal of pediatric surgery, 32(7), 1997, pp. 1083-1087
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.