Jiří Šnajdauf

Long-term outcomes of balloon dilation of esophageal strictures in children

RATIONALE AND OBJECTIVES The purpose of this study was to determine the long-term success of the use of angioplasty balloons for dilation of esophageal strictures in children. MATERIALS AND METHODS The authors studied 24 children who had undergone fluoroscopically guided angioplasty balloon dilation of esophageal strictures. Ten children had stricture of the anastomosis after surgical repair of esophageal atresia; five had achalasia; three had strictures due to gastroesophageal reflux; three had corrosive strictures; two had congenital stenosis; and one had stricture after radiation therapy. Success was defined as resolution of the dysphagia a year after dilation. RESULTS A year after the last dilation, 15 of the 24 children had no dysphagia. Patients in whom treatment was successful included eight children with strictures after surgery for esophageal atresia, one with achalasia, three with strictures caused by gastroesophageal reflux, one with a corrosive stricture, one with congenital stenosis, and one with a stricture resulting from radiation therapy. CONCLUSION The long-term results of balloon catheter dilation are highly successful in patients with stricture after surgical repair of esophageal atresia and stricture due to gastroesophageal reflux. Dilation is not as valuable in the treatment of esophageal strictures resulting from other causes.

Delayed diagnosis of a right-sided traumatic diaphragmatic rupture

Right-sided traumatic diaphragmatic rupture in childhood is a very rare injury. Diaphragmatic rupture often manifests itself later, after an organ progressively herniates into the pleural cavity. When the patient is tubed, the ventilation pressure does not allow herniation of an organ, which occurs when the patient is ex-tubed. We present a patient with a delayed diagnose of right sided diaphragmatic rupture with a complicated post-operation state.

Congenital segmental aplasia of the intestinal muscularis: a rare disorder mimicking necrotizing enterocolitis

Both infants of a pair of dizygotic twins born in the 26th week of gestation presented with intolerance of feedings, bilious gastric aspirates, abdominal distension, and fixed, dilated bowel loops on X-ray. Necrotizing enterocolitis (NEC) was suspected. Medical treatment failed, and the infants were operated upon on days 12 and 19 of life. Ballon-like dilated segments of ileum were removed and ileostomies performed. The diagnosis of congenital segmental aplasia of the intestinal muscularis was made from histologic examination in both cases. This disorder is a rare cause of intestinal obstruction or perforation in premature babies. Its course may resemble NEC; medical therapy inevitably fails; and surgical treatment is associated with a favorable outcome. The literature on absence of the intestinal muscularis in neonates is reviewed and possible etiologies are discussed.