Unusual variant of esophageal atresia and tracheo-esophageal fistula: A case report

Rachael Stottlemyre , David M. Notrica , Mark McOmber , Erin Garvey
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Abstract

Introduction

Esophageal atresia (EA) is the most common congenital anomaly affecting the esophagus. We describe an unusual variant of EA, which shares similarities with Type A but features a mid-esophageal segment attached to the trachea.

Case presentation

A 38-week gestational age baby girl had prenatal diagnoses of EA and congenital cardiac anomalies. Postnatal attempts to advance an orogastric tube were unsuccessful, and EA was confirmed by chest X-ray showing the tube at the T2/T3 level without distal bowel air. Further workup included bronchoscopy, which identified a posterior tracheal outpouching without an apparent connection to the esophagus, and Cardiac CT, which revealed a mid-esophageal segment with a tracheo-esophageal fistula. Workup was consistent with complex esophageal anatomy with distinct proximal and distal pouches and a mid-esophageal segment attached to the trachea. A gastrostomy tube was placed for decompression and enteral feeds. Surgical intervention included closure and excision of the mid-esophageal fistula. The gap between the proximal and distal pouches was impressive, requiring cervical esophageal mobilization and two esophageal myotomies to add length, and concluded in a primary esophago-esophagostomy. Postoperative complications included a contained leak at the anastomosis, which was managed conservatively with placement of a feeding tube past the anastomotic site and resolved after 4 weeks. The patient required multiple esophageal dilations during the first two years of life and achieved successful closure of the gastrostomy at 25 months of age without further complications.

Conclusion

Awareness of rare subtypes of EA enables surgeons to anticipate and address unique challenges that may arise during surgical intervention.
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食管闭锁和气管食管瘘的异常变异:病例报告
导言食道闭锁(EA)是影响食道的最常见先天性畸形。我们描述了一种不同寻常的食管闭锁变异型,它与A型食管闭锁相似,但食管中段与气管相连。病例介绍 一名妊娠38周的女婴产前被诊断为食管闭锁和先天性心脏畸形。产后尝试推进口胃管未成功,胸部 X 光片显示插管位于 T2/T3 水平,且远端肠道无空气,证实为 EA。进一步检查包括支气管镜检查和心脏 CT,前者发现气管后部有一个气管外口,但没有明显的食管连接;后者发现食管中段有一个气管食管瘘。检查结果显示食管解剖结构复杂,近端和远端有明显的小囊,食管中段与气管相连。为减压和肠道进食放置了胃造瘘管。手术治疗包括关闭和切除食管中段瘘管。近端和远端瘘袋之间的间隙非常大,需要进行颈部食管移动和两次食管肌切开术来增加长度,最后进行了食管-食管造口术。术后并发症包括吻合口处的渗漏,当时采取了保守治疗,在吻合口处放置了一根喂食管,4周后渗漏消失。该患者在出生后的头两年需要进行多次食管扩张,在 25 个月大时成功关闭了胃造口,没有再出现并发症。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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