Utilization of chest tube as an esophagus stent in pediatric caustic injuries: A retrospective study

Abstract

BACKGROUND The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. AIM To describe how to utilize a chest tube for esophageal stenting in pediatrics. METHODS Data regarding the etiology, treatment, and complications of caustic injury in pediatrics over 10 years was collected retrospectively. Furthermore, data regarding the patient's follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patient's cheek. RESULTS During the period of our study, data from 57 patients with an average age of 2.5 years (range 1-12; SD = 1.7) were obtained. The results showed that 89% of esophageal injury was due to alkaline and 9.4% were caused by acidic agents. The treatment methods showed that 29 patients (50.8%) recovered with dilatation alone. In 16 patients (28.06%), the esophageal repair was performed by using the colon, and in 5 patients (8.7%), other surgical methods were used and in 7 patients (12.2%), the ECT stents were used. ECT was inserted in 7 cases with a mean age of 2 (range: 1.5-3) years who were classified as grade IIB or III. Grading was performed by endoscopy assessment on the first day. Antibiotics and corticosteroids were administrated as initial medical management for all patients. ECT implantation was done during the first 8 d for 5 out of 7 cases (mean: 3.8 d). For the 2 patients, ECT was used after 27 (patient 6) d and 83 (patient 7) d. The reason for late stenting in these patients was a postponed referral to our center, in which patient 7 even received 4 dilation episodes before visiting our center. ECT was removed after an average of 44 d in the first 5 patients, while in the other 2 patients (6 and 7) was 2 and 1 wk, respectively. There was no complication related to, or failure of, stent placement. It is worth mentioning that none of the 7 ECT cases required gastrostomy or jejunostomy. CONCLUSION The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.

Conduction System Disease in Victims of COVID-19

“…In addition, the high incidence of S1Q3T3 and LBBB in this study could be an indicator of pulmonary involvement in COVID-19 victims. S1Q3T3 is a relatively specific pattern for pulmonary thromboembolism and a potential cause of death (21,(34)(35)(36)(37). Moreover, assessing ECG parameters in conduction system disease in victims of COVID-19, ST-T changes, fragmented QRS, axis deviation, presence of S1Q3T3, and poor R wave progression were significantly related to conduction disease in victims of COVID-19.…”

Systematic review of the significance of neutrophil to lymphocyte ratio in anastomotic leak after gastrointestinal surgeries

“…The overall prognosis of these patients is worsened by AL following gastric resections, with substantial morbidity and death rates that might exceed 60% [3][4][5]. Additionally, AL is linked to increased short-term mortality and higher healthcare system expenses [6][7][8][9][10][11]. A systematic review is necessary to inform clinical decision-making since recent studies on this subject are constantly being published.…”