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A rare and fatal complication of oesophagoscopy. Anaesthetic implications
N A Zubair1, D R Patil, A H Alghamdi
1King Fahad Hospital, Al-Baha, Saudi Arabia.
Insights
A child suffered cardiac arrest after caustic soda ingestion caused an esophageal stricture. Attempts at ventilation led to pneumopericardium, a rare complication, and unsuccessful resuscitation.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Pediatric Surgery
Background:
- Caustic soda ingestion in children can lead to severe esophageal strictures requiring repeated dilatations.
- Esophageal strictures pose risks during anesthesia and airway manipulation.
- Pneumopericardium is a rare but potentially fatal complication.
Observation:
- A 3.5-year-old child with a caustic-induced esophageal stricture underwent anesthesia for dilatation.
- During ventilation, the child experienced laryngospasm, cyanosis, bradycardia, and cardiac arrest.
- Chest X-ray revealed a large pneumopericardium.
Findings:
- Pneumopericardium was successfully aspirated, but resuscitation efforts failed.
- It was presumed that manual ventilation with a closed glottis forced air through a fragile esophageal tear into the pericardium.
- This case highlights a rare mechanism of injury during airway management in pediatric esophageal stricture.
Implications:
- Emphasizes the critical risks associated with airway management in children with esophageal strictures.
- Suggests careful consideration of ventilation techniques to avoid barotrauma in fragile esophageal tissues.
- Underscores the importance of prompt recognition and management of pneumopericardium in pediatric emergencies.
Abstract:
A 3.5-year-old child developed a tight oesophageal stricture following ingestion of caustic soda. At the end of the fourth anaesthetic for oesophageal dilatation, laryngospasm and difficulty in mask ventilation was followed by cyanosis, bradycardia, and cardiac arrest. Chest X ray showed a large pneumopericardium, which was immediately aspirated, but unfortunately resuscitation was unsuccessful. It was presumed that during attempted manual ventilation of the lungs in the presence of a closed glottis, air had been accidentally forced into the pericardium through a small tear in the fragile oesophagus.