A two-year-old male was admitted to our hospital with a three-month esophageal stenosis secondary to accidental ingestion of a caustic.
The patient was referred to our institution with gastrostomy and a nasogastric suture (stringinginging) that allowed recurrent dilatations.
Barium cystogram showed a long stricture from the cricotracheal level to the lower third of the esophagus.
An esophageal dilation program was performed first. The patient was kept alive every two weeks without any improvement. Therefore, at five months post-ingestion of the corrosive agent, another 16-mm silicone stent was placed in the same way.
This procedure achieved complete dilation for one month.
The child reported pain as the only postoperative symptom that remitted spontaneously after four days.
Neither migration nor other short-term complications were observed.
When oral feeding was adequately tolerated, the patient was discharged with usual tapering (15 mg/24 hours orally) and followed up in outpatient clinics.
The stents were removed at four weeks and in the same procedure a dose of mitomycin (0.4 ml/kg) was sprayed onto the area through the irrigator of the end.
Two residual stenosis of 1 cm long at the level of the cricopharyngeal sphincter and 3 cm above the cardia were identified respectively.
The first had already been visualized during the previous endoscopic intervention, when it was impossible to place a stent in that region due to tracheal compression.
Distal esophageal stenosis required another stent (16 x 40 mm), achieving complete dilation of the stent one month after placement.
Posterior balloon dilatations were performed at four-week intervals, with a normal appearance of the mucosa in the elastic esophagus.
However, the above mentioned proximal esophageal stenosis had a poor response, so we opted for surgical resection and anastomosis through left lower cervical approach dilations with five progressively longer intervals followed by stenosis two times a month.
After two years of follow-up, the patient was discharged completely asymptomatic and with an excellent macroscopic aspect of the esophagus endoscopically and through a barium swallow study.
