Presenter Status
Fellow
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Dr. Nadia Ibrahimi
Presentation Type
Poster
Start Date
19-5-2026 12:00 PM
End Date
19-5-2026 1:00 PM
Abstract Text
Background: Refractory benign esophageal strictures (RBES) are persistent esophageal narrowings resistant to repeated surgical or endoscopic treatment. RBES may result from various causes, including chemical injury, gastroesophageal reflux disease, tracheoesophageal fistula, achalasia, or congenital esophageal stenosis (CES). CES is a rare congenital anomaly caused by tracheobronchial remnants, segmental fibrosis, or membranous diaphragm. Management varies based on severity and includes endoscopic dilation, stent placement, and surgical esophagoplasty.
Objective: We discuss a rare case of CES with spontaneous esophageal perforation after balloon dilation. Patient's course was complicated by severe stenosis requiring frequent stent replacement, stent removal, re-stenosis, and Mitomycin-C application. Case Report: This is a 2-year-old male presented with recurrent vomiting following feeds. Upper gastrointestinal series revealed a long-segment stricture with mid-thoracic tapering. Initial esophogastroduodenoscopy (EGD) revealed a 2 mm by 5 cm esophageal stricture, which was balloon-dilated to 8 mm. Subsequent EGDs demonstrated persistent stenosis, dilated up to 10 mm with triamcinolone injection, which allowed for eventual scope passage. However, one-week post-dilation, the patient developed fever, vomiting, and respiratory distress. He presented to an outside hospital with acute hypoxemic respiratory failure and tamponade physiology from a left pleural effusion due to esophageal perforation and septic shock. He was treated on broad-spectrum antibiotics, intravenous fluids, and chest tube placement after transfer to the PICU, where he required intubation and vasopressors. After stabilization, esophagram showed marked proximal esophageal dilation and nearly obstructive narrowing of the distal esophagus. EGD revealed a 4.5 cm severe stenosis at 17 cm. A biliary stent was placed and secured with endoclips. Weekly EGDs were conducted with progressive dilation by upsizing the diameter of the stent. A nasojejunal (NJ) tube was placed to support enteral feeding. At discharge, he had an esophageal stent in place and was tolerating NJ feeds. Post-discharge imaging revealed distal stent migration and family opted for stent removal. A follow up esophagram showed recurrence of near obstructive stricture. A new biliary stent was placed and secured. Patient underwent weekly EGDs with stent replacements and gradual upsizing of the diameter of the stent to a goal diameter of 16mm and Mitomycin-C application was performed as well. He is currently tolerating GJ feeds well and followed by weekly chest X-rays to monitor for stent migration. Congenital esophageal stenosis is a rare but significant cause of dysphagia, aspiration, and feeding difficulties in infants and toddlers. Management typically begins with repeated balloon dilation, which has a high success rate and low complication profile. However, esophageal perforation, while rare, is a potentially life-threatening complication of dilation, especially in cases of severe or long-segment stenosis. This case highlights the challenges in managing CES complicated by esophageal perforation. In our patient, conservative management post-perforation was effective. Serial endoscopic interventions with dilation, stent placement, and adjunct Mitomycin-C therapy were needed to manage recurrent strictures. Conclusion: Ultimately, this case emphasizes the need for a multidisciplinary approach, close monitoring, and flexibility in managing complex pediatric esophageal strictures. Endoscopic dilation remains first-line, but adjuncts like stenting and Mitomycin-C play crucial roles in refractory cases.
Refractory Benign Esophageal Strictures Complicated by Esophageal Perforation and Treated with Serial Dilations and Stent Placement in a Pediatric Patient
Background: Refractory benign esophageal strictures (RBES) are persistent esophageal narrowings resistant to repeated surgical or endoscopic treatment. RBES may result from various causes, including chemical injury, gastroesophageal reflux disease, tracheoesophageal fistula, achalasia, or congenital esophageal stenosis (CES). CES is a rare congenital anomaly caused by tracheobronchial remnants, segmental fibrosis, or membranous diaphragm. Management varies based on severity and includes endoscopic dilation, stent placement, and surgical esophagoplasty.
Objective: We discuss a rare case of CES with spontaneous esophageal perforation after balloon dilation. Patient's course was complicated by severe stenosis requiring frequent stent replacement, stent removal, re-stenosis, and Mitomycin-C application. Case Report: This is a 2-year-old male presented with recurrent vomiting following feeds. Upper gastrointestinal series revealed a long-segment stricture with mid-thoracic tapering. Initial esophogastroduodenoscopy (EGD) revealed a 2 mm by 5 cm esophageal stricture, which was balloon-dilated to 8 mm. Subsequent EGDs demonstrated persistent stenosis, dilated up to 10 mm with triamcinolone injection, which allowed for eventual scope passage. However, one-week post-dilation, the patient developed fever, vomiting, and respiratory distress. He presented to an outside hospital with acute hypoxemic respiratory failure and tamponade physiology from a left pleural effusion due to esophageal perforation and septic shock. He was treated on broad-spectrum antibiotics, intravenous fluids, and chest tube placement after transfer to the PICU, where he required intubation and vasopressors. After stabilization, esophagram showed marked proximal esophageal dilation and nearly obstructive narrowing of the distal esophagus. EGD revealed a 4.5 cm severe stenosis at 17 cm. A biliary stent was placed and secured with endoclips. Weekly EGDs were conducted with progressive dilation by upsizing the diameter of the stent. A nasojejunal (NJ) tube was placed to support enteral feeding. At discharge, he had an esophageal stent in place and was tolerating NJ feeds. Post-discharge imaging revealed distal stent migration and family opted for stent removal. A follow up esophagram showed recurrence of near obstructive stricture. A new biliary stent was placed and secured. Patient underwent weekly EGDs with stent replacements and gradual upsizing of the diameter of the stent to a goal diameter of 16mm and Mitomycin-C application was performed as well. He is currently tolerating GJ feeds well and followed by weekly chest X-rays to monitor for stent migration. Congenital esophageal stenosis is a rare but significant cause of dysphagia, aspiration, and feeding difficulties in infants and toddlers. Management typically begins with repeated balloon dilation, which has a high success rate and low complication profile. However, esophageal perforation, while rare, is a potentially life-threatening complication of dilation, especially in cases of severe or long-segment stenosis. This case highlights the challenges in managing CES complicated by esophageal perforation. In our patient, conservative management post-perforation was effective. Serial endoscopic interventions with dilation, stent placement, and adjunct Mitomycin-C therapy were needed to manage recurrent strictures. Conclusion: Ultimately, this case emphasizes the need for a multidisciplinary approach, close monitoring, and flexibility in managing complex pediatric esophageal strictures. Endoscopic dilation remains first-line, but adjuncts like stenting and Mitomycin-C play crucial roles in refractory cases.
Comments
Poster Board Number: 4