Benign oesophageal stricture - A sequel of Stevens Johnson syndrome
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《美国医学杂志》
Kanchi Kamakoti Childs Trust Hospital, 12-A, Nageswara Road, Nungambakkam, Chennai-600 034, India
A 13-year-old boy presented with dysphagia of 6 years duration, which was more for solids than for liquids. He took a long time to eat his food and was unable to swallow tablets. There was no history of cough, aspiration, GI bleed or retrosternal discomfort. He was not gaining weight as expected. His school performance was good. There was no history of corrosive ingestion, surgery or drug intake. He had Stevens Johnson syndrome at the age of 7 years following sulphonamide medication. This event was a setback and his parents were apprehensive about any from of medical treatment.
On examination he was a thin, cheerful and intelligent child with no specific findings. A diagnosis of eosophageal stricture as a complication of SJ syndrome was made based on the history. A barium swallow showed a short segment stricture in the upper oesophagus Figure1. An endoscopy was done which confirmed a stricture of 6 mm in diameter. Under fluoroscopic screening endoscopic dilatation was done with Savary Gilliard dilator till 12.8 mm. Child did remarkably well Figure2 and did not require any more dilatations. He started eating well and gained 2.5 Kg in 3 months time.
Benign oesophageal stricture of the oesophagus in children is usually secondary to accidental corrosive ingestion, post operative anastomotis, peptic, postradiation, post sclerotherapy or secondary to pill oesophagitis.[1] Rarely it can occur as a complication of Crohn's disease, epidermolysis bullosa or Stevens Johnson syndrome. In Stevens Johnson syndrome the child may have dysphagia during the acute phase which may settle spontaneously when the skin lesions heal. Rarely the oesophageal lesions may result in stricture[2] Endoscopic dilatation is an accepted method of dilatation and is of great benefit to the patient.
References
1. Broor SL, Lahoti D, Bose PP et al. Benign oesophageal strictures in children and adolescents: aetiology. clinical profile and results of endoscopic dilatation. Gastrointest Endosc 1996; 43: 474-477.
2. Tan YM, Goh KL. Oesophageal stricture as a late complication of Stevens Johnson Syndrome. Gastrointest Endosc 1999; 50: 566-568.(Sathiyasekaran Malathi, S)
A 13-year-old boy presented with dysphagia of 6 years duration, which was more for solids than for liquids. He took a long time to eat his food and was unable to swallow tablets. There was no history of cough, aspiration, GI bleed or retrosternal discomfort. He was not gaining weight as expected. His school performance was good. There was no history of corrosive ingestion, surgery or drug intake. He had Stevens Johnson syndrome at the age of 7 years following sulphonamide medication. This event was a setback and his parents were apprehensive about any from of medical treatment.
On examination he was a thin, cheerful and intelligent child with no specific findings. A diagnosis of eosophageal stricture as a complication of SJ syndrome was made based on the history. A barium swallow showed a short segment stricture in the upper oesophagus Figure1. An endoscopy was done which confirmed a stricture of 6 mm in diameter. Under fluoroscopic screening endoscopic dilatation was done with Savary Gilliard dilator till 12.8 mm. Child did remarkably well Figure2 and did not require any more dilatations. He started eating well and gained 2.5 Kg in 3 months time.
Benign oesophageal stricture of the oesophagus in children is usually secondary to accidental corrosive ingestion, post operative anastomotis, peptic, postradiation, post sclerotherapy or secondary to pill oesophagitis.[1] Rarely it can occur as a complication of Crohn's disease, epidermolysis bullosa or Stevens Johnson syndrome. In Stevens Johnson syndrome the child may have dysphagia during the acute phase which may settle spontaneously when the skin lesions heal. Rarely the oesophageal lesions may result in stricture[2] Endoscopic dilatation is an accepted method of dilatation and is of great benefit to the patient.
References
1. Broor SL, Lahoti D, Bose PP et al. Benign oesophageal strictures in children and adolescents: aetiology. clinical profile and results of endoscopic dilatation. Gastrointest Endosc 1996; 43: 474-477.
2. Tan YM, Goh KL. Oesophageal stricture as a late complication of Stevens Johnson Syndrome. Gastrointest Endosc 1999; 50: 566-568.(Sathiyasekaran Malathi, S)