Thorac Cardiovasc Surg 2018; 66(05): 396-400
DOI: 10.1055/s-0037-1600518
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Conservative Treatment with Octreotide to Provide Early Recovery of Children with Esophageal Perforation

Ramazan Karabulut
1   Department of Pediatric Surgery, Gazi Universitesi Tip Fakultesi Ringgold Standard Institution, Ankara, Turkey
,
Zafer Turkyilmaz
2   Gazi University Medical Faculty, Department of Pediatric Surgery, Besevler, Ankara, Turkey
,
Kaan Sonmez
2   Gazi University Medical Faculty, Department of Pediatric Surgery, Besevler, Ankara, Turkey
,
Abdullah Can Basaklar
2   Gazi University Medical Faculty, Department of Pediatric Surgery, Besevler, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

18 November 2016

12 February 2017

Publication Date:
24 March 2017 (online)

Abstract

Background The effectiveness of nonoperative treatment of esophageal perforation (EP) in children with octreotide is highlighted.

Methods Records of nine patients (seven boys and two girls with an average age of 5.83 ± 5.35 years) with EP were reviewed.

Results EP developed in six patients during dilation of esophageal stenosis (five of six caused by caustic burns). In the other three patients, EP developed after nasogastric placement, after endotracheal intubation, and during endoscopy for foreign body. The symptoms consisted of dyspnea in four patients, tachypnea in seven patients, fever in six patients, chest pain in two patients, and abdominal pain in one patient. Two patients had pneumomediastinum, four patients had pleural effusion, one patient had subcutaneous emphysema, four patients had pneumothorax, and two patients had severe sepsis. Eight of the perforations resolved spontaneously. Therapy included cessation of oral feedings, implementation of proper antibiosis, parenteral and/or enteral nutrition by gastrostomy, and drainage of pleural effusions or mediastinal abscesses if required. Though not recommended by literature, octreotide was administered to these patients. Only one patient was operated in another clinic and was lost during follow-up. The length of hospitalization stay had a median of 11 ± 6.59 days, ranging between 5 and 28 days. If the patient who was operated and did not receive octreotide therapy is excluded, the median hospitalization was only 8 days (5 to 12 days). All patients in our series (except patient 8) survived and still have their native esophagus.

Conclusion The initiation of octreotide treatment in the early period after diagnosis of EP without surgical intervention leads to early improvement in children.

 
  • References

  • 1 Kim-Deobald J, Kozarek RA. Esophageal perforation: an 8-year review of a multispecialty clinic's experience. Am J Gastroenterol 1992; 87 (09) 1112-1119
  • 2 Martinez L, Rivas S, Hernández F. , et al. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003; 38 (05) 685-689
  • 3 Garey CL, Laituri CA, Kaye AJ. , et al. Esophageal perforation in children: a review of one institution's experience. J Surg Res 2010; 164 (01) 13-17
  • 4 Karabulut R, Karakuş C, Hirfanoğlu I. , et al. Treatment of postoperative enterocutaneous fistulas with octreotide in two neonates. Eur J Pediatr Surg 2008; 18 (01) 56-58
  • 5 Kaygusuz I, Celik O, Ozkaya O, Yalçin S, Keleş E, Cetinkaya T. Effects of interferon-alpha-2b and octreotide on healing of esophageal corrosive burns. Laryngoscope 2001; 111 (11 Pt 1): 1999-2004
  • 6 Eroglu A, Turkyilmaz A, Aydin Y, Yekeler E, Karaoglanoglu N. Current management of esophageal perforation: 20 years experience. Dis Esophagus 2009; 22 (04) 374-380
  • 7 Gupta NM, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004; 187 (01) 58-63
  • 8 Heikenen JB, Pohl JF, Werlin SL, Bucuvalas JC. Octreotide in pediatric patients. J Pediatr Gastroenterol Nutr 2002; 35 (05) 600-609
  • 9 Hesse U, Ysebaert D, de Hemptinne B. Role of somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data. Gut 2001; 49 (Suppl. 04) iv11-iv21
  • 10 Nubiola P, Badia JM, Martinez-Rodenas F. , et al. Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995. Ann Surg 1989; 210 (01) 56-58
  • 11 Sancho JJ, di Costanzo J, Nubiola P. , et al. Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula. Br J Surg 1995; 82 (05) 638-641
  • 12 Swanson MS, Hudson RL, Bhandari N, Sinha UK, Maceri DR, Kokot N. Use of octreotide for the management of chyle fistula following neck dissection. JAMA Otolaryngol Head Neck Surg 2015; 141 (08) 723-727
  • 13 Spinell C, Ricci E, Berti P, Miccoli P. Postoperative salivary fistula: therapeutic action of octreotide. Surgery 1995; 117 (01) 117-118