University of Nigeria Virtual Library Serial No. AGUGUA, N.E.N Author 1 Author 2 Author 3 Colon Bypass for Corrosive Esophageal Strictures in Title Nigeria Children Keywords Colon Bypass for Corrosive Esophageal Strictures in Description Nigeria Children Category Publisher Publication Date February, 1988 Digitally signed by Ojionuka Arinze B. Ojionuka DN: CN = Ojionuka Arinze B., C = US, O = University of Nigeria, Nsukka, OU = Innovation Centre Signature Reason: I have reviewed this Arinze B. document Date: 2007.02.18 20:16:40 -08'00'
' ORIGINAL ARTICLES w Colon bypass for corrosi~ v e oesophageal strictures in Nigerian children. E. N. N. Agugua Alessandrini has indicated that titrated extracts of Centella ABSTRACT Asiatica could be used to dissolve corrosive oesophageal strictu- bypass res (5). Until such time as this drug becomes widely available . . j v r araarurruvss s v r r w * r c vsauyrsugcus rrr*a,rurcu wlth~n and useful, surgery remains as a method of treatment. This pa- u - r g - r , the I0;vearperiod of January 1978 to December 1987. Cervical per presents a 10-year experience of retrosternal transverse co- complications accounted for 60% and the commonest was a lon bypass for intractable corrosive oesophageal stricture in Ni- leak at the colo-oesophageal anastomosis. There was one death gerian children. due to undetected oesophago-tracheal fistula. The longest fol- low up was 10 years. MATERIALS AND METHODS Records of 15 children who had colon bypass surgery for cor- RIASSUNTO rosive oesophageal strictures at the University of Nigeria Tea- Tra il gennaio I978 ed il dicembre 1987 quindici bambini di ching Hospital, Enugu, within the 10-ytar.periud of 1978 to 1987 were reviewed. This series has not included other oesopha- etd compresa fra i tre ed i dodici annisono statisottoposti ad in- geal diseases like oesophageal atresia nor tracheo-oesophageal tervento di bypass eso fageo con colon-interposizione per steno- fistulae. Patients with corrosive strictures who have failed oeso- si da ingestione di caustici. 1 1 60% dele complicanze interessa- phageal dilatation and in whom the length of stricture is more vano la regione cervicale e la pit) comune t? stata la deiscenza than 66% of the oesophagus were offered a colonic bypass sur- dell'anastomosi colon-esofagea. Un decesso si t? verificato per gery. The T o stricture was calculated as una fistola esofago-tracheale non diagnosticata. I 1 follow-up va 100 lenght of stricture on X-ray da 3 mesi a 10 anni. 1 lenght of oesophagus on X-ray All patients were initially managed with a feeding gastrosto- KEY WORDS my until the weight gain was considered adequate for the age. The barium swallow was used to measure the Ienght of the stric- Oesophageal strictures, Colon bypass ture (Fig. 1). The width of the strictured organ as seen on the X-ray was not taken as significant. Stricture of the oesophagus consequent on corrosive burns is a common disease in the Nigerian environment. Infants under 2 years appear immuned due to the utmost protection they get from being tied at the mothers back. Corrosive fluids ingested range from battery fluids to hairdressers lotions, washing up li- quids and local pests' poisons. In most cases, the initial treat- , ment is given at the primary and secondary health care centers. The tertiary or specialist center deals with the resultant strictu- res. Lundblad in 1921 was the first to describe the use of the tran- sverse colon for total oesophageal replacement (I). He interpo- sed the transverse colon between the cervical oesophagus and the stomach in a 3-year old child with a lye stricture. Other sur- geons before him have replaced the oesophagus with skin tubes (Bircher 1984)(2), Jejunum (Roux 1907)C). and combined skin and colon (Kelling 191 From: Department of Paediatric Surgery - College of Medici- ne - University of Nigeria Teaching Hospital - Enugu - Nigeria. Address reprint requests to: dott. N. E. N. Agugua, Depart- ment of Paediatric Surgery, College of Medicine, University of Figure 1 : Stricture of 80% of the oesophagus. Initial barium 129 - Enugu - Nigeria. Nigeria Teaching Hospital. P.M.B. 01 study. It. J. Ped. Surg. Sci. - Vol. 2, No. 1-2 - 1988 7
Operative technique. Two paediatric surgeons worked synchronously using cervi- cal and abdominal routes. In no case was the thorax opened. The abdominal surgeon isolated the transverse colon, did a co- loncolic anastomosis to restore continuity of the gut, and a ga- strocolic anastomosis to transport food to the intact stomach. He delivered the isoperistaltic oesophageal transplant to the neck surgeon via the retrosternal space. The cervical surgeon sectioned the oesophagus, closed the distal end and anastomo- sed the proximal end to the colon. Case I A 3-year old male child of a military personnel ingested bleech and obtained a stricture of 70% of the oesophagus. On referral 6 months after the episode he already had a feeding ga- strostomy and an unremitting cough. The cause of the cough could not be identified pre-operatively. Chest X-rays were nor- mal. Attempts at oesophageal bouginage failed. He had a tran- sverse colon bypass surgery via the retrosternal space. Posto- pertively he developed an intractable chest infection and respi- ratory distress which led to his death 14 days after surgery. At postmortem an oesophago-tracheal fistula was found as a com- plication of his corrosive stricture. Case 2 A 6-year old male child of a hairdresser ingestkd caustic soda and obtained a corrosive stricture of 80% of the oesophagus. Fig. 1 shows his initial barium swallow on referral. He commen- Figure 3:Colon bypass, chest picture, post-operative barium ced serial oesophageal dilatation and a subsequent barium swal- study. low (Fig. 2) showed upper oesophageal dilatation with Figure 4:Colon bypass, abdominal picture, post-operative ba- Figure 2: Upper oesophageal dilatation during conservative ma- rium study. nagement. symptoms of regurgitation and aspiration pneumonitis. A ga- RESULTS strostomy was performed for feeding and when he had gained Altogether, there were 9 males and 6 females in this series, adequate weight he was subjected to a colon bypass surgery. and their ages ranged between 3 and 12 years (Tab. 1). Weight Postoperatively, he did well and a barium study (Figs. 3 and 4) showed the functioning colonic transplant.,A reflux was not de- gain was obvious by 3 months after surgery. The commonest monstrated. complication (Tab. 2) was a leak at the cervical anastomosis It. J. Ped. Surg. Sd. - Vol. 2, No. 1-2 - 1988 8
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