gms | German Medical Science

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.