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Pediatric esophagopleural fistula: Two case reports and a literature review
Yun Cui1, Yuqian Ren, Yijun Shan
1Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Insights
Esophagopleural fistula (EPF) in children is rare and often misdiagnosed. Conservative treatment shows promise for pediatric EPF, with key findings including unilateral pleural effusion with food residue.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Gastroenterology
Background:
- Esophagopleural fistula (EPF) is a rare condition in children with a high misdiagnosis rate.
- Understanding the clinical manifestations and management strategies for pediatric EPF is crucial.
Observation:
- This study analyzed two pediatric EPF cases and reviewed 38 studies involving 197 EPF patients.
- Common causes in children include iatrogenic factors, esophageal foreign bodies, and infections.
- Key clinical signs are unilateral pleural effusion with food residue.
Findings:
- Chest CT and contrast esophagography are accurate diagnostic tools for EPF.
- Conservative treatment was successful in one pediatric case (cervical trauma), while dual stent implantation cured another (endoscopic dilation).
- Surgical treatment in adults significantly improves cure rates and reduces mortality compared to conservative methods.
Implications:
- Pleural effusion with food residue is a specific indicator for EPF diagnosis.
- Chest CT demonstrates high sensitivity in diagnosing EPF.
- Conservative management may be the preferred approach for pediatric EPF patients.
Abstract:
Esophagopleural fistula (EPF) is rarely reported in children with a high misdiagnosis rate. This study aimed to reveal the clinical manifestations and managements of EPF in children.Two pediatric cases of EPF in our hospital were reported. A bibliographic search was performed on the PubMed, WANFANG, and CNKI databases for EPF-related reports published between January 1980 and May 2016. The pathogeny, clinical manifestations, diagnosis, treatments, and prognosis of EPF patients were collected and discussed.Based on conservative treatments, 1 pediatric EPF case induced by cervical trauma was cured by longitudinal septum incision-mediated drainage. The other pediatric EPF induced by endoscopic balloon dilation was cured by dual stent implantation. A total of 38 studies of 197 EPF patients (191 adults and 6 children) were reviewed. Latrogenic factor, esophageal foreign body, and infection are considered the main causes of EPF in children. Unilateral pleural effusion accompanied by food residue was the main manifestations of EPF. Chest computed tomography (CT) and contrast esophagography were usually used in the diagnosis of EPF with high accuracy. Surgical treatment in adults with EPF exhibited a significantly higher cure rate and lower mortality rate than conservative treatment (P < .01).Pleural effusion with food residue is a specific finding in EPF. Chest CT exhibited high sensitivity for the diagnosis of EPF. Conservative treatment may be preferable for pediatric patients with EPF.
