Abstract
Background The effectiveness of nonoperative treatment of esophageal perforation (EP) in children
with octreotide is highlighted.
Methods Records of nine patients (seven boys and two girls with an average age of 5.83 ±
5.35 years) with EP were reviewed.
Results EP developed in six patients during dilation of esophageal stenosis (five of six
caused by caustic burns). In the other three patients, EP developed after nasogastric
placement, after endotracheal intubation, and during endoscopy for foreign body. The
symptoms consisted of dyspnea in four patients, tachypnea in seven patients, fever
in six patients, chest pain in two patients, and abdominal pain in one patient. Two
patients had pneumomediastinum, four patients had pleural effusion, one patient had
subcutaneous emphysema, four patients had pneumothorax, and two patients had severe
sepsis. Eight of the perforations resolved spontaneously. Therapy included cessation
of oral feedings, implementation of proper antibiosis, parenteral and/or enteral nutrition
by gastrostomy, and drainage of pleural effusions or mediastinal abscesses if required.
Though not recommended by literature, octreotide was administered to these patients.
Only one patient was operated in another clinic and was lost during follow-up. The
length of hospitalization stay had a median of 11 ± 6.59 days, ranging between 5 and
28 days. If the patient who was operated and did not receive octreotide therapy is
excluded, the median hospitalization was only 8 days (5 to 12 days). All patients
in our series (except patient 8) survived and still have their native esophagus.
Conclusion The initiation of octreotide treatment in the early period after diagnosis of EP
without surgical intervention leads to early improvement in children.
Keywords
esophageal perforation - conservative management - octreotide
