SummaryA 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 dificulty 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. Key wordsComplications; pneumopericardium, death. Gastrointestinal tract; oesophagus. Surgery ; oesophagoscopy.In children, oesophagoscopy is usually performed to dilate a stricture or to remove a foreign body. Perforation of the oesophagus, pneumomediastinum, mediastinitis, pneumothorax and surgical emphysema are some of the complications of this technique. We report the development of tension pneumopericardium in a child following oesophagoscopy under general anaesthesia.Case history A 3.5-year-old boy was brought to the emergency room with a history of ingestion of caustic soda (sodium hydroxide granules) which is extensively used as drain opener in Saudi Arabia. Clinical examination showed evidence of chemical burns in the oral cavity and marked oedema of the soft palate, with ulceration of the posterior pharyngeal wall. The rest of the systemic and biochemical examination was normal. X ray of the chest was also normal. The child was treated conservatively with intravenous fluids, antibiotics and hydrocortisone and was discharged after 4 days in hospital.Four weeks later the child was re-admitted with recurrent vomiting and refusing to eat or drink. On examination, he was markedly dehydrated and malnourished and there was dribbling of saliva which he was unable to swallow. Systemic examination and chest X ray was essentially normal. Barium swallow and examination showed extensive mucosal ulceration, oedema and narrowing of the lumen of the oesophagus. The pylorus was the size of a pin hole and the child underwent a pyloroplasty. During the subsequent visit upper gastro-intestinal endoscopy was performed under general anaesthesia. A tight stricture of 7-8 cm in length was noted, which started at 7cm from the central incisor and finished 2 cm from the oesophagogastric junction. The stricture was dilated gradually up to 1 1 mm (5, 7,9, 11 mm) using the Savory Gillard dilators and re-endoscopy confirmed adequate dilation. The child underwent three dilations under general anaesthesia at 2-3 week intervals without any complications.Twelve weeks after the initial admission the child was again brought to the hospital with increasing dysphagia, even to semi-solid food and fluids. A pre-operative assessment was done by a consultant anaesthetist. The family was informed about the possible complications and consent was obtained. He was a child of average height and body build (body weight 15 kg). He had no cough or na...

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