Management of digestive lesions associated to congenital epidermolysis bullosa

• Published in: African journal of paediatric surgery Vol. 12; no. 4; pp. 221 - 226
• Main Authors: Chahed, Jamila, Mekki, Mongi, Ksia, Amine, Kechiche, Nehla, Hidouri, Saida, Youssef, Trimech Monia, Sahnoun, Lassaad, Krichene, Imed, Belghith, Mohsen, Nouri, Abdellatif
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-10-2015; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abdomen; Care and treatment; Child; Complications and side effects; Congenital epidermolysisbullosa; Development and progression; Digestive symptoms; Digestive System Surgical Procedures - methods; Disease Management; Epidermolysis bullosa; Epidermolysis Bullosa - complications; Epidermolysis Bullosa - diagnosis; Epidermolysis Bullosa - surgery; Esophageal Stenosis - diagnosis; Esophageal Stenosis - etiology; Esophageal Stenosis - surgery; Esophagoscopy; Fluoroscopy; Follow-Up Studies; Gastric Outlet Obstruction - complications; Gastric Outlet Obstruction - diagnosis; Gastric Outlet Obstruction - surgery; Humans; Infant, Newborn; Male; Mortality; Mutation; Nutrition; oesophageal stenosis; Original; Pediatric diseases; pyloric atresia; Pylorus - abnormalities; Pylorus - surgery; Radiography, Thoracic; Retrospective Studies
• ISSN: 0189-6725; 0974-5998
• DOI: 10.4103/0189-6725.172544

Congenital epidermolysis bullosa (CEB) is a rare genodermatosis. The digestive system is very frequently associated with skin manifestations. Pyloric atresia (PA) and oesophageal stenosis (OS) are considered the most serious digestive lesions to occur.The aim of this work is to study the management and the outcome of digestive lesions associated to CEB in four children and to compare our results to the literature.
A retrospective study of four observations: Two cases of PA and two cases of OS associated to CEB managed in the Paediatric Surgery Department of Fattouma Bourguiba Teaching Hospital in Monastir, Tunisia.
Four patients, two of them are 11 and 8 years old, diagnosed as having a dystrophic epidermolysis bullosa since the neonatal period. They were admitted for the investigation of progressive dysphagia. Oesophageal stenosis was confirmed by an upper contrast study. Pneumatic dilation was the advocated therapeutic method for both patients with a favourable outcome. The two other patients are newborns, diagnosed to have a CEB because of association of PA with bullous skin lesions with erosive scars. Both patients had a complete diaphragm excision with pyloroplasty. They died at the age of 4 and 3 months of severe diarrhoea resistant to medical treatment.
Digestive lesions associated to CEB represent an aggravating factor of a serious disease. OS complicating CEB is severe with difficult management. Pneumatic dilatation is the gold standard treatment method. However, the mortality rate in PA with CEB is high. Prenatal diagnosis of PA is possible, and it can help avoiding lethal forms.