Frequency and medical management of esophageal perforation after pneumatic dilatation in achalasia

Endoscopic clipping of a complicated esophageal perforation following pneumatic dilation for achalasia: A case study and literature review

A transmural esophageal tear complicated by large size and unusual location was diagnosed in a 59-year-old man after undergoing pneumatic balloon dilation for achalasia. It was closed with six endo-clips. The patient recovered and was discharged with ordinary diet 8 days later, after receiving supportive care for a week.

Bildgebung

Ergibt sich aus dem pränatalen Ultraschallbefund oder durch klinische Hinweise der Verdacht auf eine Entwicklungsstörung des Darms des Neugeborenen, so ist die Situation am sichersten durch eine Röntgenaufnahme, und zwar des Thorax und Abdomens im Liegen oder im Hängen, zu klären.

Le mégaœsophage de l'enfant : profil clinique et évolution à long terme

Achalasia of the cardia is rare in children. We report our experience in the management of 20 children with achalasia.

PATIENTS

Twenty children (seven girls including two sisters) with achalasia were studied, seven of them had a morbid association. Age at diagnosis ranged from eight months to 18 years (med: 6.4 yrs). Duration of symptoms prior to diagnosis ranged from one to 62 months (med: 8 months). Regurgitations, weight loss and recurrent pneumonias were the most common presenting symptoms. Diagnosis was established using esophageal manometry, which showed aperistalsis throughout the esophageal body with impaired relaxation of lower esophageal sphincter in all children, and chest x-ray and barium esophagram, which were abnormal in 11 and 18 children respectively.

OUTCOME

Nifedipine used in nine children was ineffective. Two balloon dilatations were performed in one child with a poor result. Surgery with Heller's myotomy combined with an antireflux procedure was performed in 19 children. One child died six months later due to an hypoglycemic coma. During the follow-up (6 months-21 years) symptoms reappeared in five children. Seventy-two percent of the children had no symptoms one year after the surgery and 45%, five years after. Esophageal manometry performed after surgery in seven children showed a normal lower esophageal sphincter pressure but with impaired relaxation, and an aperistalsis throughout the esophageal body. These results justify prolonged follow-up of children with achalasia of the esophagus.