Pediatr Surg Int (1991) 6:42-43 Pediatric SarNery International © Springer-Verlag 1991 Case report Brain abscess: an unusual complication of multiple esophageal dilatations Carlos Angel, Earle Wrenn, and Thorn Lobe Department of Pediatric Surgery, LeBonheur Children's Medical Center, Memphis, Tennessee, USA Accepted June 4, 1990 Abstract. Lye ingestion in children continues to be a prob- lem and may result in severe esophageal strictures. Esoph- ageal dilatations to treat these strictures usually result in bacteremia. A case of a 13-year-old boy who developed a brain abscess after multiple esophageal dilatations is pre- sented and discussed and the literature on the subject is reviewed. Key words: Esophageal stricture -Esophageal dilatation - Brain abscess - Lye ingestion Case report A 13-year-old white male was admitted with complaints of vomiting, dysphagia, and acute weight loss. His problems had begun 3 weeks prior to admission when he swallowed capsules containing Drano. Shortly afterward he experienced nausea and vomiting and was taken to a local emergency room, where gastric lavage was performed and cephalexin was prescribed for pharyngitis. Physical examination on admission showed a thin but otherwise normal adolescent. An esophagram showed a long, tight stricture at the junction of the middle and lower third of the esophagus. This finding was confirmed by esophagoscopy and dilatation to a 22 Fr caliber was possible. A Stamm gastrostomy was performed and a string was passed. Over a period of 31/2 months, repeated string- guided dilatations were performed under general anesthesia on a total of 11 occasions. On his third admission the patient experienced peridilata- tion fever up to 39 ° that lasted for 48 h but resolved with a course of treatment with trimethoprim-sulfamethoxazole. A soluble contrast esophagogram during this admission showed a small, contained ex- travasation of contrast. Two months later the patient was dilated up to 38 Fr caliber with Maloney bougies. Five days later he presented to the emergency room complaining of left-sided weakness and paresthesias of the tongue, throat, left arm, leg, and foot. He appeared lethargic and was drooling. Physical examination disclosed no other signs of lateralization. ACT scan of the head showed a right parietotemporal mass consistent with a brain abscess (Fig. 1). This finding was confirmed at craniotomy and the abscess was drained. Treatment with intravenous antibiotics Offprint requests to: C. Angel, Department of Surgery, St. Jude Chil- dren's Research Hospital, 332 North Lauderdale, Memphis, TN 38101, USA Fig. 1. CT scan showing a right parietotemporal brain abscess (cefotaxime and chloramphenicol) was initiated and continued for 8 weeks. Two subsequent aspirations of the abscess cavity were required. Cultures showed growth of peptostreptococcus, Eikenella corrodens and Streptococcus viridans. The patient recovered from his brain abscess with no neurologic sequelae. Two additional esophageal dilatations were performed using prophylactic erythromycin, but the stricture was re- sistant to dilatation. A partial esophageal resection and replacement with a reverse gastric tube was performed and the patient has done well ever since. Discussion Ingestion of concentrated caustic substances is a common problem in pediatrics. To our knowledge this is the first time that an esophageal stricture has been reported to occur after ingestion of caustics in capsules obtained at school. Experimentally, caustic agents can cause full-thickness bums of the esophagus after exposure times as short as 1 s, and the ingestion of even very small quantities can result in