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Gastropleural Fistula in a Child with Acute Lymphoblastic Leukemia Due to Perforated Gastric Ulcer

Sanjeev Khera1, Karunesh Chand2, Atul Mishra3

  • 1Department of Pediatrics, Army Hospital Research & Referral, Delhi, 110010, India. kherakherakhera@gmail.com.

Indian Journal of Pediatrics
|May 19, 2021
PubMed

Insights

Gastropleural fistula (GPF) is a rare condition connecting the stomach and chest cavity. This case highlights a pediatric GPF caused by steroid-induced gastric perforation in a leukemia patient, successfully treated with surgical repair.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Pulmonology

Background:

  • Gastropleural fistula (GPF) is a rare condition involving abnormal communication between the stomach and pleural space.
  • While documented in adults from various causes, GPF in children is exceptionally uncommon.
  • Potential causes include iatrogenic injury, trauma, malignancy, and complications of other conditions.

Purpose of the Study:

  • To report an extremely rare case of gastropleural fistula in a pediatric patient.
  • To identify the etiology and management of GPF in a child with leukemia.
  • To emphasize the diagnostic and therapeutic challenges associated with pediatric GPF.

Main Methods:

  • Case report of a female child diagnosed with leukemia.
  • Clinical presentation included left-sided pneumonia and chylothorax.
  • Diagnosis of GPF was established after a 3-week delay, attributed to a perforated gastric ulcer from high-dose steroid therapy.

Main Results:

  • The patient presented with symptoms suggestive of a complex thoracic complication.
  • A gastropleural fistula was confirmed as the underlying cause.
  • The perforated gastric ulcer was linked to steroid treatment for leukemia.

Conclusions:

  • Gastropleural fistula, though rare, can occur in children, particularly those undergoing intensive medical treatment.
  • High-dose steroid therapy in pediatric patients may precipitate gastric ulceration and subsequent fistula formation.
  • Prompt diagnosis and surgical repair of GPF are crucial for favorable outcomes in pediatric cases.

Keywords:
Gastropleural fistulaLeukemiaPerforated gastric ulcer

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