Esophageal blast injury caused by fireworks in a seven-year-old male child. A rare case report

Esophageal blast injury caused by fireworks in a seven-year-old male child. 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A rare case report Ahmad Abdalkareem, Bushra Alsahen, Diaa Sadeq, Jaber Mahmood This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7330529/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted 11 You are reading this latest preprint version Abstract Background esophageal blast injuries are uncommon and are usually caused by gunshots, but they have never been reported in the medical literature as being caused by fireworks. Moreover, most available clinical evidence supports early surgical management without sufficient evidence about the benefits of conservative management. Case presentation a seven-year-old boy had fired a small firework and immediately had swallowed it, after that he subsequently developed extensive facial, neck, and upper chest swelling. In the emergency department, the patient was hemodynamically stable, and there was no history of dysphagia, dyspnea, or hoarseness. He was evaluated radiologically via CT scans and esophagograms, which revealed mediastinal pneumothorax and extensive pneumosubcutaneous, as well as the formation of an esophageal diverticulum and a pseudo-Pathy within the esophageal wall. We decided to adopt conservative esophageal management with discontinuous oral feeding. One month later, upper gastrointestinal endoscopy was performed, which demonstrated improvement in the degree of esophageal injury, and then oral feeding was gradually reintroduced until complete dependence was achieved. Conclusion esophageal blast injuries may result from extremely rare causes, such as fireworks, and that can be serious. However, conservative management can be provided when a patient has hemodynamically stable and that could have benefits, such as a reduced recovery time and complications of esophageal injury. esophageal blast injury firework esophageal diverticulum pneumosubcutaneous pneumothorax gastrostomy Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Fireworks remain one of the most common causes of blast injuries in patients, with the hands being the most commonly injured body part (30.0%), followed by the head and neck (22.2%) and then the eyes (21.5%)( 1 ). Esophageal blast injuries are rare perforations that differ from perforating or penetrating trauma in that high-pressure external or pneumatic blasts cause an increase in intraluminal pressure that exceeds the tensile strength of the wall( 2 ). In the emergency room, patients may present with acute chest pain, dyspnea, and findings such as pneumomediastinum or pneumosubcutaneous, and they may have relative hypotension, bradycardia, slowed respirations, and lowered Glasgow Coma scores( 3 , 4 ). Traumatic injury of the esophagus is usually diagnosed by CT scan or flexible endoscopy, but if there is a delay, a water-soluble contrast examination is indicated, and primary repair is the most commonly employed procedure irrespective of the location of the esophageal injury( 4 , 5 ). In our case, we report an exceptionally rare case of esophageal blast injury caused by fireworks, which is a novel mechanism not previously documented, to raise awareness of this extreme presentation and draw attention to the benefits of conservative management of esophageal blast injuries without the need for extensive surgical intervention. Case presentation A 7-year-old previously healthy male child presented to our pediatric emergency department with a history of swallowing small fireworks after fires. The incident occurred two days prior to unsupervised play, and within hours, the patient developed noticeable facial, cervical, and upper chest swelling. There was no history of shortness of breath, difficulty swallowing, or hoarseness. On initial examination, the patient was alert, cooperative, and oriented to time, place, and person. Vital signs were stable, and physical inspection revealed soft tissue swelling involving the face, neck, upper chest, and back. Subcutaneous crepitus was clearly observed by palpation, particularly in the neck and chest regions. No active bleeding, ecchymosis, or signs of external trauma were present, and auscultation of the chest sounds was acceptable except for a slight decrease in the bases. A prior evaluation at another medical center before coming to our hospital included a chest CT scan (Fig. 1 ), which revealed massive pneumomediastinum and extensive pneumosubcutaneous in the cervical and thoracic soft tissues, and contrast esophagography (Fig. 2 ), which revealed a posterior esophageal outpouching (suspected diverticulum) with free passage of contrast agent and no apparent leakage. The patient was referred to our hospital (Children University Hospital) without prior therapeutic intervention. On admission, a new contrast esophagogram (Fig. 3) was done and revealed that a large posteriorly located esophageal diverticulum in the upper third of the esophagus, in addition to pseudo-Pathy extended approximately 12.5 cm with a re-entry point into the esophageal lumen distally, but no contrast extravasation was observed. Owing to the stabilization of the patient's hemodynamic status, the complexity of the case and concerns about esophageal integrity when surgery is performed, we decided to proceed with conservative treatment by stopping oral feeding and making an alternative feeding route. A Stamm gastrostomy was performed to support the patient's daily nutritional needs, and the patient was subsequently discharged in stable condition with a follow-up plan for one month. After one month, the patient was in good condition, and a very good clinical examination was performed. For re-evaluation, we conducted upper gastrointestinal endoscopy (Fig. 4 ), which revealed remnants of a healed injury in the esophagus without stricture or edema. In light of the favourable radiologic and clinical evolution, oral feeding was gradually reintroduced over two weeks, starting with liquids and progressing to solid foods. The patient tolerated oral intake well, with no signs of dysphagia, regurgitation, or vomiting. As a result, the gastrostomy tube was safely removed, and the patient transitioned to full oral nutrition. After a three-month follow-up, the patient was in excellent feeding condition. Discussion and conclusion Esophageal blast injury is a rare disorder due to its deep anatomical location and small size. The underlying mechanism is often a penetrating gunshot wound (47.7)( 4 ). The injury typically involves the cervical esophagus, to a lesser extent the thoracic esophagus, and rarely the abdominal esophagus( 4 ). Firework-related injuries often involve exposed areas of the body, such as the hands, head, neck, and eyes, and rarely involve internal organs( 1 ). In this case, the fireworks caused an esophageal blast injury, resulting in the formation of a large diverticulum in the cervical esophagus with a pseudo-Pathy along the esophageal wall of approximately 12.5 meters, with an esophageal lumen adjoining the lower end. On the basis of the available evidence, computed tomography (CT) is usually the first choice for diagnosing esophageal blast injuries, with the possibility of using esophagograms as available. Flexible endoscopy is less commonly used. We performed a CT scan, which revealed a large mediastinal perforation with extensive pneumosubcutaneous. Given the patient's hemodynamic stability, we performed an esophagogram to determine the need for surgical intervention. Most studies recommend early surgical intervention on the basis of the presence of a radiographic leak and hemodynamic stability( 5 ). In the absence of established guidelines, the final decision rests on personal clinical experience. Potential surgical interventions include surgical repair of the esophageal perforation, flexible endoscopic stenting, or even esophageal replacement or stoma( 5 ). We decided against either of these options. With haemodynamic stability and the onset of spontaneous remission of the pneumomediastinum, we decided to proceed with conservative treatment of the esophagus, allowing it to heal spontaneously. The patient was stopped from oral feeding for one month, with an alternative feeding route provided via a gastrostomy. A month later, upper gastrointestinal endoscopy showed regression of the previous esophageal diverticulum and pseudo-Pathy. Therefore, it was decided to gradually reintroduce feedings, progressing from liquids to solids with good gastrointestinal tolerance, and then remove the mixture via gastrostomy. The patient was followed up in our gastroenterology clinic 3 months later and was able to return to normal daily activities and oral feeding well. Surgical treatment of penetrating esophageal injuries increases the recovery time( 5 ), and the decision to proceed with conservative treatment reduces the need for this. In conclusion, we highlight a novel form of esophageal blast injury caused by an extremely rare ingestion like fireworks. This can result in severe gastrointestinal and thoracic injuries despite the absence of severe prognostic symptoms. This case highlights the importance of early radiological evaluation via available means and the possibility of adopting conservative management if the patient's hemodynamic status is stable and signs of leakage or perforation is not found. This can be achieved with close clinical and radiological follow-up, thus avoiding the risks and complications of direct surgical intervention. We also highlight the effectiveness of a stopping oral feeding and nutritional support via gastrostomy in accelerating the healing and avoiding prolonged hospitalization. Declarations Ethical approval Ethical approval was provided by the Ethical Committee of Damascus University. Consent of publication Informed consent to publish this case report was provided by the patient’s parents. Data availability No datasets were generated or analysed during the current study. Competing interests The authors declare that they have no competing interests. Funding No external funding was received for this study. Author contributions Ahmad Abdalkareem, Bushra Alsahen and Diaa Sadeq wrote the manuscript. Jaber Mahmood participated in clinical practice and edited the manuscript. All the authors have read and approved the final manuscript. Acknowledgements Not applicable. Clinical trial number Not applicable. References Billock RM, Chounthirath T, Smith GA. Pediatric firework-related injuries presenting to United States emergency departments, 1990–2014. Clin Pediatr. 2017;56(6):535–44. Elsolh B, Ko M, Cheung V, Gomez D. Oesophageal rupture from a pneumatic blast injury: an unusual mechanism of blunt oesophageal trauma. BMJ Case Rep CP. 2021;14(6):e242218. Roan J-N, Wu M-H. Esophageal perforation caused by external air-blast injury. J Cardiothorac Surg. 2010;5(1):130. Makhani M, Midani D, Goldberg A, Friedenberg FK. Pathogenesis and outcomes of traumatic injuries of the esophagus. Dis Esophagus. 2014;27(7):630–6. Papaconstantinou D, Kapetanakis EI, Mylonakis A, Davakis S, Kotidis E, Tagkalos E, et al. Current aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis. Dis Esophagus. 2024;37(6):doae007. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 07 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers invited by journal 21 Aug, 2025 Editor invited by journal 18 Aug, 2025 Editor assigned by journal 14 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7330529","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":503619626,"identity":"380b920d-97b3-4e51-a97a-e89de40ab58b","order_by":0,"name":"Ahmad Abdalkareem","email":"data:image/png;base64,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","orcid":"","institution":"Damascus University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Abdalkareem","suffix":""},{"id":503619627,"identity":"7f538d54-a513-4ea3-a9fd-08273f4ed439","order_by":1,"name":"Bushra Alsahen","email":"","orcid":"","institution":"Damascus University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Alsahen","suffix":""},{"id":503619628,"identity":"58fab40c-41e8-4d1b-94c3-c88dfca44ee6","order_by":2,"name":"Diaa Sadeq","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Diaa","middleName":"","lastName":"Sadeq","suffix":""},{"id":503619629,"identity":"a34575d0-2475-4634-a6d9-0c82d8f25ab6","order_by":3,"name":"Jaber Mahmood","email":"","orcid":"","institution":"Damascus University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jaber","middleName":"","lastName":"Mahmood","suffix":""}],"badges":[],"createdAt":"2025-08-08 23:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7330529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7330529/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-06482-y","type":"published","date":"2026-01-09T15:58:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90311309,"identity":"ffdfe753-1aa7-4158-a480-d7e0118fc45c","added_by":"auto","created_at":"2025-09-01 09:49:22","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183872,"visible":true,"origin":"","legend":"\u003cp\u003echest CT scan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend\u003c/strong\u003e it is seen extensive mediastinal pneumothorax in the anterior and posterior mediastinum, with extensive pneumosubcutaneous. Also, it is seen atelectasis in the posterior segments of the lower lobes.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7330529/v1/f1d12b00107544112c208b1d.jpg"},{"id":90313018,"identity":"a96840bf-842f-4b76-b6b8-512efa7b1b07","added_by":"auto","created_at":"2025-09-01 10:05:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":209100,"visible":true,"origin":"","legend":"\u003cp\u003efirst contrast esophagogram\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend\u003c/strong\u003e It is seen a posterior diverticulum is seen in the mid-esophagus that severely narrows the posterior anterior diameter of the esophagus, and contrast material collects in its lumen. No extravasation of contrast material outside the esophageal lumen was observed.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7330529/v1/09a9ab219c82bfd698396b58.jpg"},{"id":90311310,"identity":"45c2e5d2-4716-4b9f-b1e7-fdbb28a832d0","added_by":"auto","created_at":"2025-09-01 09:49:22","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":202527,"visible":true,"origin":"","legend":"\u003cp\u003esecond contrast esophagogram\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend\u003c/strong\u003e There is seen a degree of irregularity in the esophageal wall and a large, posterior diverticulum in the upper third of the esophagus that continues in a pseudo-Pathy approximately 12.5 cm, ending with the lower end of esophagus without extravasation of contrast material outside the lumen of the esophagus or the described pseudo-Pathy.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7330529/v1/aa243bb655aec66d96dd69ee.jpg"},{"id":90311312,"identity":"6304d0ea-1b04-4b27-8448-787990246f58","added_by":"auto","created_at":"2025-09-01 09:49:22","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":75658,"visible":true,"origin":"","legend":"\u003cp\u003eupper gastrointestinal endoscopy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend\u003c/strong\u003e it is seen 3 cm long healed wound at the site of the previous injury, the rest of the esophageal wall is normal.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7330529/v1/e2e0d6430e74819025dfced3.jpg"},{"id":100069305,"identity":"744946e8-0ecf-4a5a-afd8-852774ccf492","added_by":"auto","created_at":"2026-01-12 16:12:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1037903,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7330529/v1/05756776-8aa9-455a-9522-248b5023fad2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Esophageal blast injury caused by fireworks in a seven-year-old male child. A rare case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFireworks remain one of the most common causes of blast injuries in patients, with the hands being the most commonly injured body part (30.0%), followed by the head and neck (22.2%) and then the eyes (21.5%)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Esophageal blast injuries are rare perforations that differ from perforating or penetrating trauma in that high-pressure external or pneumatic blasts cause an increase in intraluminal pressure that exceeds the tensile strength of the wall(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the emergency room, patients may present with acute chest pain, dyspnea, and findings such as pneumomediastinum or pneumosubcutaneous, and they may have relative hypotension, bradycardia, slowed respirations, and lowered Glasgow Coma scores(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Traumatic injury of the esophagus is usually diagnosed by CT scan or flexible endoscopy, but if there is a delay, a water-soluble contrast examination is indicated, and primary repair is the most commonly employed procedure irrespective of the location of the esophageal injury(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In our case, we report an exceptionally rare case of esophageal blast injury caused by fireworks, which is a novel mechanism not previously documented, to raise awareness of this extreme presentation and draw attention to the benefits of conservative management of esophageal blast injuries without the need for extensive surgical intervention.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 7-year-old previously healthy male child presented to our pediatric emergency department with a history of swallowing small fireworks after fires. The incident occurred two days prior to unsupervised play, and within hours, the patient developed noticeable facial, cervical, and upper chest swelling. There was no history of shortness of breath, difficulty swallowing, or hoarseness. On initial examination, the patient was alert, cooperative, and oriented to time, place, and person. Vital signs were stable, and physical inspection revealed soft tissue swelling involving the face, neck, upper chest, and back. Subcutaneous crepitus was clearly observed by palpation, particularly in the neck and chest regions. No active bleeding, ecchymosis, or signs of external trauma were present, and auscultation of the chest sounds was acceptable except for a slight decrease in the bases. A prior evaluation at another medical center before coming to our hospital included a chest CT scan (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which revealed massive pneumomediastinum and extensive pneumosubcutaneous in the cervical and thoracic soft tissues, and contrast esophagography (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which revealed a posterior esophageal outpouching (suspected diverticulum) with free passage of contrast agent and no apparent leakage. The patient was referred to our hospital (Children University Hospital) without prior therapeutic intervention. On admission, a new contrast esophagogram (Fig.\u0026nbsp;3) was done and revealed that a large posteriorly located esophageal diverticulum in the upper third of the esophagus, in addition to pseudo-Pathy extended approximately 12.5 cm with a re-entry point into the esophageal lumen distally, but no contrast extravasation was observed. Owing to the stabilization of the patient's hemodynamic status, the complexity of the case and concerns about esophageal integrity when surgery is performed, we decided to proceed with conservative treatment by stopping oral feeding and making an alternative feeding route. A Stamm gastrostomy was performed to support the patient's daily nutritional needs, and the patient was subsequently discharged in stable condition with a follow-up plan for one month. After one month, the patient was in good condition, and a very good clinical examination was performed. For re-evaluation, we conducted upper gastrointestinal endoscopy (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e), which revealed remnants of a healed injury in the esophagus without stricture or edema. In light of the favourable radiologic and clinical evolution, oral feeding was gradually reintroduced over two weeks, starting with liquids and progressing to solid foods. The patient tolerated oral intake well, with no signs of dysphagia, regurgitation, or vomiting. As a result, the gastrostomy tube was safely removed, and the patient transitioned to full oral nutrition. After a three-month follow-up, the patient was in excellent feeding condition.\u003c/p\u003e"},{"header":"Discussion and conclusion","content":"\u003cp\u003eEsophageal blast injury is a rare disorder due to its deep anatomical location and small size. The underlying mechanism is often a penetrating gunshot wound (47.7)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The injury typically involves the cervical esophagus, to a lesser extent the thoracic esophagus, and rarely the abdominal esophagus(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Firework-related injuries often involve exposed areas of the body, such as the hands, head, neck, and eyes, and rarely involve internal organs(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In this case, the fireworks caused an esophageal blast injury, resulting in the formation of a large diverticulum in the cervical esophagus with a pseudo-Pathy along the esophageal wall of approximately 12.5 meters, with an esophageal lumen adjoining the lower end. On the basis of the available evidence, computed tomography (CT) is usually the first choice for diagnosing esophageal blast injuries, with the possibility of using esophagograms as available. Flexible endoscopy is less commonly used. We performed a CT scan, which revealed a large mediastinal perforation with extensive pneumosubcutaneous. Given the patient's hemodynamic stability, we performed an esophagogram to determine the need for surgical intervention. Most studies recommend early surgical intervention on the basis of the presence of a radiographic leak and hemodynamic stability(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the absence of established guidelines, the final decision rests on personal clinical experience. Potential surgical interventions include surgical repair of the esophageal perforation, flexible endoscopic stenting, or even esophageal replacement or stoma(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). We decided against either of these options. With haemodynamic stability and the onset of spontaneous remission of the pneumomediastinum, we decided to proceed with conservative treatment of the esophagus, allowing it to heal spontaneously. The patient was stopped from oral feeding for one month, with an alternative feeding route provided via a gastrostomy. A month later, upper gastrointestinal endoscopy showed regression of the previous esophageal diverticulum and pseudo-Pathy. Therefore, it was decided to gradually reintroduce feedings, progressing from liquids to solids with good gastrointestinal tolerance, and then remove the mixture via gastrostomy. The patient was followed up in our gastroenterology clinic 3 months later and was able to return to normal daily activities and oral feeding well. Surgical treatment of penetrating esophageal injuries increases the recovery time(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and the decision to proceed with conservative treatment reduces the need for this.\u003c/p\u003e\u003cp\u003eIn conclusion, we highlight a novel form of esophageal blast injury caused by an extremely rare ingestion like fireworks. This can result in severe gastrointestinal and thoracic injuries despite the absence of severe prognostic symptoms. This case highlights the importance of early radiological evaluation via available means and the possibility of adopting conservative management if the patient's hemodynamic status is stable and signs of leakage or perforation is not found. This can be achieved with close clinical and radiological follow-up, thus avoiding the risks and complications of direct surgical intervention. We also highlight the effectiveness of a stopping oral feeding and nutritional support via gastrostomy in accelerating the healing and avoiding prolonged hospitalization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was provided by the Ethical Committee of Damascus University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent to publish this case report was provided by the patient’s parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAhmad Abdalkareem, Bushra Alsahen and Diaa Sadeq wrote the manuscript. Jaber Mahmood participated in clinical practice and edited the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBillock RM, Chounthirath T, Smith GA. Pediatric firework-related injuries presenting to United States emergency departments, 1990\u0026ndash;2014. Clin Pediatr. 2017;56(6):535\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElsolh B, Ko M, Cheung V, Gomez D. Oesophageal rupture from a pneumatic blast injury: an unusual mechanism of blunt oesophageal trauma. BMJ Case Rep CP. 2021;14(6):e242218.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoan J-N, Wu M-H. Esophageal perforation caused by external air-blast injury. J Cardiothorac Surg. 2010;5(1):130.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakhani M, Midani D, Goldberg A, Friedenberg FK. Pathogenesis and outcomes of traumatic injuries of the esophagus. Dis Esophagus. 2014;27(7):630\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapaconstantinou D, Kapetanakis EI, Mylonakis A, Davakis S, Kotidis E, Tagkalos E, et al. Current aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis. Dis Esophagus. 2024;37(6):doae007.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"esophageal blast injury, firework, esophageal diverticulum, pneumosubcutaneous, pneumothorax, gastrostomy","lastPublishedDoi":"10.21203/rs.3.rs-7330529/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7330529/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eesophageal blast injuries are uncommon and are usually caused by gunshots, but they have never been reported in the medical literature as being caused by fireworks. Moreover, most available clinical evidence supports early surgical management without sufficient evidence about the benefits of conservative management.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e\u003cp\u003ea seven-year-old boy had fired a small firework and immediately had swallowed it, after that he subsequently developed extensive facial, neck, and upper chest swelling. In the emergency department, the patient was hemodynamically stable, and there was no history of dysphagia, dyspnea, or hoarseness. He was evaluated radiologically via CT scans and esophagograms, which revealed mediastinal pneumothorax and extensive pneumosubcutaneous, as well as the formation of an esophageal diverticulum and a pseudo-Pathy within the esophageal wall. We decided to adopt conservative esophageal management with discontinuous oral feeding. One month later, upper gastrointestinal endoscopy was performed, which demonstrated improvement in the degree of esophageal injury, and then oral feeding was gradually reintroduced until complete dependence was achieved.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eesophageal blast injuries may result from extremely rare causes, such as fireworks, and that can be serious. However, conservative management can be provided when a patient has hemodynamically stable and that could have benefits, such as a reduced recovery time and complications of esophageal injury.\u003c/p\u003e","manuscriptTitle":"Esophageal blast injury caused by fireworks in a seven-year-old male child. A rare case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:49:17","doi":"10.21203/rs.3.rs-7330529/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-07T08:06:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T21:06:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T06:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207715769381775782473625045791896725696","date":"2025-09-18T06:26:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96918775771203570305919445252976344071","date":"2025-09-16T19:47:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39082246497469126540630894046117098401","date":"2025-09-16T11:50:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-21T09:03:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-18T18:40:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T05:42:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T05:40:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-08-08T23:47:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88bb2f77-468e-4449-831e-6943514f47a7","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:03:33+00:00","versionOfRecord":{"articleIdentity":"rs-7330529","link":"https://doi.org/10.1186/s12887-025-06482-y","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2026-01-09 15:58:10","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-09-01 09:49:17","video":"","vorDoi":"10.1186/s12887-025-06482-y","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06482-y","workflowStages":[]},"version":"v1","identity":"rs-7330529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7330529","identity":"rs-7330529","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}