Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report
Introduction: Spontaneous esophago-esophageal fistulization is a reported phenomenon in cases of complex esophageal atresia, however, short and long-term complications are common, including stricture formation. Case presentation: A male twin was born at 29 + 6 weeks gestation weighing 1103 g. Passag...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-04-01
|
| Series: | Journal of Pediatric Surgery Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S221357662500017X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825199385728778240 |
|---|---|
| author | S. Tan Tanny S.E. Newman M. Safe W.J. Teague |
| author_facet | S. Tan Tanny S.E. Newman M. Safe W.J. Teague |
| author_sort | S. Tan Tanny |
| collection | DOAJ |
| description | Introduction: Spontaneous esophago-esophageal fistulization is a reported phenomenon in cases of complex esophageal atresia, however, short and long-term complications are common, including stricture formation. Case presentation: A male twin was born at 29 + 6 weeks gestation weighing 1103 g. Passage of a nasogastric tube was attempted but coiled in the upper esophagus, leading to a postnatal diagnosis of esophageal atresia with distal tracheo-esophageal fistula. At thoracotomy on day 1 of life, the tracheo-esophageal fistula was ligated without problems. Esophageal anastomosis to overcome a 1–1.5 vertebral body gap was attempted but abandoned following significant intraoperative anesthetic complications. Instead, the upper and lower esophageal ends were sutured closed and then apposed under tension using interrupted 4/0 Ethibond®. A contrast study on day 18 of life demonstrated spontaneous anastomosis of the esophageal ends, with reflux of contrast between the upper and lower esophagus, and no extraluminal contrast extravasation. Subsequent contrast studies at ages 4 weeks, 5, 10 and 13 months, and 2 years showed no anastomotic stricture. Upper gastrointestinal endoscopy at the age of 2 years showed no esophagitis. Gastro-esophageal reflux symptoms remain controlled with medication and no fundoplication has been performed. High resolution esophageal manometry at the age of 3 years demonstrated weak, but coordinated, distal peristalsis. At the age of 4.5 years, the patient is tolerating an unrestricted diet and has a growth curve that matches the curve of his twin sibling. Conclusion: In cases where primary esophageal anastomosis is not possible, opposing the upper and lower pouches with sutures may result in spontaneous esophageal anastomosis not necessarily associated with an anastomotic stricture. |
| format | Article |
| id | doaj-art-0004cbb428334a66b23408e3e782e1e5 |
| institution | Kabale University |
| issn | 2213-5766 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj-art-0004cbb428334a66b23408e3e782e1e52025-02-08T05:00:23ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662025-04-01115102972Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case reportS. Tan Tanny0S.E. Newman1M. Safe2W.J. Teague3Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, AustraliaDepartment of Neonatal Medicine, The Royal Children's Hospital, Melbourne, AustraliaDepartment of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, AustraliaDepartment of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Corresponding author. Department of Paediatric Surgery The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, 3032, Australia.Introduction: Spontaneous esophago-esophageal fistulization is a reported phenomenon in cases of complex esophageal atresia, however, short and long-term complications are common, including stricture formation. Case presentation: A male twin was born at 29 + 6 weeks gestation weighing 1103 g. Passage of a nasogastric tube was attempted but coiled in the upper esophagus, leading to a postnatal diagnosis of esophageal atresia with distal tracheo-esophageal fistula. At thoracotomy on day 1 of life, the tracheo-esophageal fistula was ligated without problems. Esophageal anastomosis to overcome a 1–1.5 vertebral body gap was attempted but abandoned following significant intraoperative anesthetic complications. Instead, the upper and lower esophageal ends were sutured closed and then apposed under tension using interrupted 4/0 Ethibond®. A contrast study on day 18 of life demonstrated spontaneous anastomosis of the esophageal ends, with reflux of contrast between the upper and lower esophagus, and no extraluminal contrast extravasation. Subsequent contrast studies at ages 4 weeks, 5, 10 and 13 months, and 2 years showed no anastomotic stricture. Upper gastrointestinal endoscopy at the age of 2 years showed no esophagitis. Gastro-esophageal reflux symptoms remain controlled with medication and no fundoplication has been performed. High resolution esophageal manometry at the age of 3 years demonstrated weak, but coordinated, distal peristalsis. At the age of 4.5 years, the patient is tolerating an unrestricted diet and has a growth curve that matches the curve of his twin sibling. Conclusion: In cases where primary esophageal anastomosis is not possible, opposing the upper and lower pouches with sutures may result in spontaneous esophageal anastomosis not necessarily associated with an anastomotic stricture.http://www.sciencedirect.com/science/article/pii/S221357662500017X |
| spellingShingle | S. Tan Tanny S.E. Newman M. Safe W.J. Teague Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report Journal of Pediatric Surgery Case Reports |
| title | Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report |
| title_full | Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report |
| title_fullStr | Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report |
| title_full_unstemmed | Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report |
| title_short | Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report |
| title_sort | spontaneous anastomosis of esophageal atresia without esophageal stricture formation a case report |
| url | http://www.sciencedirect.com/science/article/pii/S221357662500017X |
| work_keys_str_mv | AT stantanny spontaneousanastomosisofesophagealatresiawithoutesophagealstrictureformationacasereport AT senewman spontaneousanastomosisofesophagealatresiawithoutesophagealstrictureformationacasereport AT msafe spontaneousanastomosisofesophagealatresiawithoutesophagealstrictureformationacasereport AT wjteague spontaneousanastomosisofesophagealatresiawithoutesophagealstrictureformationacasereport |