P1.040. VATS Repair in an Latrogenic Esophageal Perforation in a 4-Year-Old Boy – A Case Report

Abstract

Abstract Topic Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications Case Submission We report a case of a 4 years old boy, with a history of a coin ingestion, which appears to be stuck at the level of cricopharynx on X-ray study. Patient was taken up in OT by the ENT/Head & Neck team for removal of foreign body under general anesthesia. Removal of foreign body was attempted using a Rigid Esophagoscope but failed to retrieved – the coin slipped further down into the esophagus during the procedure (by the time UGIE was done, the coin was seen at the GE Junction). The surgery team was called in to remove the foreign body using a Flexible Upper GI Scope. On performing UGI scope, it was noted that the esophagus had perforated at Right lateral wall ~20cm from incisors. It was also noted that the Spo2 dropped despite the patient being under General Anesthesia – patient had developed pneumothorax. The coin was retrieved and an intercostal tube was immediately inserted. It was then decided to perform a VATS repair of the esophageal perforation – after consulting with Medical Gastroenterologist and Pediatric surgeon. VATS repair of the esophageal perforation was performed using 3-0 vicryl, with wide spectrum antibiotic therapy. Patient was managed in ICU for 24 hours NG tube was placed and the patient was kept Nil per oral for 5 days. On POD 5, oral contrast study was done – no contrast leak. Patient was started on oral diet, intercostal tube removed on POD 7 and patient got discharged in a good and stable condition.