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Updated: Aug 17, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Improved survival in children with esophageal perforation
S A Engum1, J L Grosfeld, K W West
1Department of Surgery, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, USA.
Insights
Pediatric esophageal perforation, often iatrogenic, requires prompt diagnosis and treatment to minimize complications. Early intervention significantly improves outcomes, with a lower mortality rate in children compared to adults.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal perforation in children is a rare but serious condition.
- Underlying esophageal diseases like atresia and gastroesophageal reflux increase risk.
- Iatrogenic causes, including dilatation and antireflux procedures, are common.
Purpose of the Study:
- To analyze the causes, locations, symptoms, and outcomes of pediatric esophageal perforation.
- To evaluate treatment strategies and identify factors influencing morbidity and mortality.
- To compare pediatric outcomes with adult esophageal perforation data.
Main Methods:
- Retrospective review of hospital and office records.
- Analysis of 24 children treated for esophageal perforation between 1975 and 1995.
- Data collection on diagnosis, treatment, complications, and mortality.
Main Results:
- Iatrogenic causes accounted for 17 perforations, with trauma in 6.
- Common symptoms included dysphagia, dyspnea, and fever.
- Complications were more frequent with delayed diagnosis (73%); mortality was 4%.
Conclusions:
- Delayed diagnosis and therapy are linked to increased morbidity and mortality.
- Primary closure is often successful, allowing esophageal salvage.
- Pediatric mortality (4%) is substantially lower than in adults (25%-50%).
Objective:
To analyze the cause, location, signs and symptoms, presence of underlying disease, time interval to diagnosis, treatment, and morbidity and mortality in 24 children (19 boys and 5 girls) with esophageal perforation who were treated from 1975 to 1995.
Design:
Data were collected retrospectively from hospital and office records.
Setting:
A tertiary care children's hospital.
Results:
The average age at diagnosis was 58 months (range, 1 day to 19 years). Fourteen children had underlying esophageal disease (atresia, n = 7 and gastroesophageal reflux, n = 7). Iatrogenic perforations occurred in 17 children: 8 during dilatation, 5 during an antireflux procedure, 2 during endoscopy, and 2 after passage of a feeding tube. Trauma was the cause of perforation in 6 children. In 2 cases the cause was unknown. Perforation occurred in the thoracic esophagus in 12 cases, abdominal esophagus in 7, cervical esophagus in 5, and involved both the thoracic and abdominal esophagus in 1. Signs and symptoms included dysphagia (15 patients), dyspnea (14), fever (12), cyanosis (8), abdominal pain (6), chest pain (5), and subcutaneous emphysema (3). Management of esophageal perforation included nonoperative management (7 patients), drainage alone (1), primary closure (16), and resection and diversion (1). Two perforations occurred in 1 child. Complications occurred in 11 (44%) of the 25 cases and were more common after delayed diagnosis (73%). The average hospital stay was 20 days. There was 1 death (4%) attributed to esophageal perforation.
Conclusions:
Morbidity and mortality are directly related to delays in diagnosis and therapy. Most cases of esophageal perforation in children can be closed primarily and the esophagus salvaged despite delayed presentation. The mortality rate in children with esophageal perforation (4%) is significantly less than that for adults (25%-50%).
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