All were in adults older than 50 years. The 2 patients with mediastinitis were treated successfully with antibiotics. Our case appears to be the first one of perforation of EIP with associated mediastinitis in a child. Despite the potential morbidity and mortality, the patient recovered successfully with conservative therapy. Unlike other forms of esophageal perforation, that from a ruptured EIP is likely microscopic and is sealed off relatively rapidly by the surrounding tissue reaction.
Contamination is therefore limited, thus allowing adequate control with antibiotics alone.
It is apparent that pediatric EIP is most likely a result of long-standing chronic esophagitis. The etiology of the esophagitis should be identified and aggressive treatment should be instituted to avoid possible progression to perforation. Wong and Walton are from the Division of Pediatric Surgery and Dr. Issenman is from the Division of Gastroenterology, Children's Hospital, Hamilton Health Sciences Corporation, Hamilton, Ont. Accepted for publication July 27, 1998. Richart C. Esophageal intramural pseudodiverticulosis.