gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Self-bougienage of oesophageal stricture by an 8-year-old child

Meeting Abstract

Suche in Medline nach

  • Peer Wildbrett - Universitätsmedizin Greifswald, Klinik und Poliklinik für Kinderchirurgie, Greifswald
  • Carsten Müller - Universitätsmedizin Greifswald, Klinik und Poliklinik für Kinderchirurgie, Greifswald
  • Winfried Barthlen - Universitätsmedizin Greifswald, Klinik und Poliklinik für Kinderchirurgie, Greifswald

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch498

DOI: 10.3205/12dgch498, URN: urn:nbn:de:0183-12dgch4989

Veröffentlicht: 23. April 2012

© 2012 Wildbrett et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: We present the case of a severe malnourished Afghan child with recurrent high-grade stenosis of the upper oesophagus due to ingestion of battery acid (Figure 1 [Fig. 1]). He first underwent repeated wire-guided oesophageal dilations. Immediately after the procedures, the patient was able to tolerate solid food but soon he deteriorated and represented with dysphagia and weight loss. The resistance to therapy and the special circumstances of this case with no chance of a long-term follow-up directed us to the possibility of self-bouginage.

Materials and methods: The fasting child was sitting on a stretcher with reclined head. The tip of the bougie was inserted into the pharynx, where the gag reflex opened the upper oesophageal sphincter and allowed insertion of the bougie into the oesophagus. When the resistance of the stricture was encountered, the bougie was carefully forced through it, hold for a few seconds and removed. The procedure was daily performed on the ward. Within 2 months, the dilator size was sequentially increased up to 11 mm. Initially, the bouginage was only performed by the surgeon but step by step, the patient was more involved in the procedure. First, he was bringing the tip of the dilator to his pharynx and after insertion of the bougie by the surgeon, he removed it by himself. Later, the patient was able to perform the whole procedure by himself.

Results: The patient was finally discharged home after one year. He is independently performing the oesophageal self-bouginage every day. There is no food restriction, no dysphagia and therefore a satisfying weight increase of 9 kg.

Conclusion: In conclusion, we have been shown that even in the early childhood, self-bouginage of an oesophageal stricture is possible. It might be an option to provide a high quality of life in developing countries with absence of specialised health care.