Congenital esophageal stenosis diagnosed in an infant at 9 month of age

Esophageal stenosis: A case of delayed dysphagia in an infant from northern Tanzania

Introduction and importance

Congenital stenosis of the esophagus is often overlooked in children with feeding difficulties leading to delayed diagnosis and treatment. This can have detrimental effects on the child's growth and general health, ranging from malnutrition to life-threatening complications such as aspiration pneumonia.

Case presentation

We present a case diagnosed at the age of 3 years when the child already had developed moderate malnutrition and offer the diagnostic and surgical findings in the hope of helping others suspect and clench the diagnosis early.

Clinical discussion

With an incidence of up to 1 in 25,000, congenital stenosis of the esophagus is definitely a congenital malformation worth knowing about, particularly since misdiagnosis often leads to delayed intervention as was in our case. History of feeding difficulty and failure to thrive are often the triggers to seeking medical attention. The confirmation can be easily made with contrast imaging opening up the possibility for surgical and non-surgical management.

Conclusion

With a high index of suspicion, diagnosis can be made relatively easily, allowing for early intervention, which can prove to be lifesaving.

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History of feeding difficulty and failure to thrive should raise suspicion.

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Contrast radiology and endoscopy can easily confirm the diagnosis.

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Treatment can be surgical or non-surgical depending on size, location and number.

Congenital esophageal stenosis: a rare malformation of the foregut

Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.

Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Aim:

To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.

Materials and Methods:

Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.

Results:

Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.

Conclusion:

Esophageal injuries though rare can be potentially devastating and life-threatening.