Esophageal caustic injuries and colon interposition in children: Long-term follow-up

Background : As sodium hydroxide (NaOH) is frequently used as a cleaning agent for air conditioners in southern Iran, caustic esophageal injuries happen frequently especially in children. After undergoing several dilatation procedures of the esophagus, a number of these patients eventually require colon interposition, an operation by which the esophagus is replaced by a segment of colon. Colon interposition is a surgical treatment modality for patients with severe caustic injuries in the esophagus. This study describes the technique and results of colon interposition in patients who had undergone this operation.
Materials and Methods : All patients who underwent colon interposition in Nemazee Hospital affiliated to Shiraz University of Medical Sciences in southern Iran from April 1990 to April 2005, were enrolled in our study. Medical records of these patients were reviewed and they were called for a follow-up examination. Out of 18 patients, only eight patients responded. They underwent clinical examination, laboratory tests, imaging and endoscopy.
Results : Growth retardation was seen in all cases. All radiographs of the chest revealed peribronchial thickening. Redundancy was seen in 60% of the patients. Lower junction stenosis, diverticulum and dilatation of the esophagus were commonly visible. Epigastric fullness (85%), dysphagia (57%), halitosis (45%), heartburn (45%), vomiting (45%), odynophagia (28%) and abdominal pain (28%) were the most common complications. There were no mortalities in our series.
Conclusions : As growth retardation was the most common complication of colon interposition in children, an appropriate nutritional support seems to be necessary after the operation.

Keywords
Caustic injury, children, colon interposition, complications, esophagus