Acute Crit Care.  2018 Nov;33(4):276-279. 10.4266/acc.2016.00829.

Iatrogenic Intramural Dissection of the Esophagus after Insertion of a Laryngeal Mask Airway

• Kim HY
• Baek SH
• Cho YH
• Kim JY
• Choi YM
• Choi EJ
• Yoon JP
• Park JH

• KMID: 2441247
• DOI: http://doi.org/10.4266/acc.2016.00829

Abstract

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an i-gel® (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an i-gel®. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

Keyword

esophageal injury; iatrogenic disease; laryngeal masks

MeSH Terms

Anesthesia
Anesthesia, General
Cicatrix
Deglutition Disorders
Esophagitis
Esophagus*
Herniorrhaphy
Humans
Iatrogenic Disease
Infant
Lacerations
Laryngeal Masks*
Male
Minor Surgical Procedures
Proton Pumps
Proton Pumps

Figure

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  Figure 1. (A) Videofluoroscopic swallowing study results showing aspiration. (B, C) Esophagography findings. Radiocontrast leaked into the left side of the upper esophagus, which was 5 cm long. (D) Gastroendoscopy findings. An opening (black arrow) was observed from the site that passed from the lower pyriform sinus of the aryepiglottic fold to the upper esophagus.

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  Figure 2. Gastroendoscopy findings on postdischarge day 11. (A) A whitish mucosal lesion (red arrow), which looked like a scar, was observed just below the aryepiglottic fold. (B) Previous lesions suggestive of esophageal duplication were almost healed and were the size of a pinhole (black arrow).

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