Pediatric emergency medicine trisk 4077 4077
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Following repair of esophageal atresia or fistula, patients may present at any
point in life with an anastomotic stricture and/or an impacted food bolus with the
site of retention typically at the site of anastomosis. These patients also tend to
have poor or disordered esophageal motility and a propensity to have
gastroesophageal reflux, which may contribute to stricture formation. Patients
who present to the ED with dysphagia or intolerance of solids and/or liquids in
the setting of a prior history of esophageal atresia repair should undergo contrast
esophagography. Typically, these patients do not have respiratory symptoms, but
if they do, a chest radiograph should be obtained. The patient should be made nil
per os , and if a stricture or obstruction from impacted food or foreign body is
demonstrated on the contrast study (Fig. 124.3 ), intravenous access and a
surgical consultation should be obtained. Patients who present with a stricture
following fistula or esophageal atresia repair are typically managed with
esophagoscopy under general anesthesia with removal of any impacted foreign
material and bougie or balloon dilation of the stricture. Most such patients are
discharged home after these interventions. Some patients require multiple
dilations over the course of their childhoods.
