Esophageal perforation: Biliary self-expandable metal stent to the rescue!

Esophageal perforation is a rare but critical emergency that requires early detection and prompt management. Iatrogenic esophageal injury is the most common cause of esophageal perforation in children, and most cases occur during endoscopic dilatation of strictures. There are various options available for the management of iatrogenic esophageal perforation, such as conservative management, endoscopic interventions, or surgical interventions. Surgical interventions for esophageal perforation have a high risk of perioperative morbidity and mortality. Endoscopic metal stenting is one of the minimally invasive treatment options for the management of esophageal perforation. However, this procedure is rarely implemented in the pediatric population due to the unavailability of appropriately size-matched endoscopic accessories. Here, we report a case of a 22-month-old male child born with a tracheoesophageal fistula, who underwent corrective surgery twice and developed anastomotic site esophageal stricture. The patient developed esophageal perforation during endoscopic dilatation of the stricture and was managed successfully with a biliary fully covered self-expandable metal stent.