EN
TÜRKÇE
Poster - 56
Long gap oesophagus atresia, a challenging primary repair.
I Apostolopoulou, I Chronopoulou, G Iordanoglou, N Kelaidi, C Siouli, C Petropoulou, N Gkavera, A Krikri
Children's Hospital Agia Sofia, Athens, Greece
Introduction
Esophageal atresia with or without tracheoesophageal fistula , is a rare congenital anomaly with incidence of approximately 1 in 3500 to 1 to 4000 births. Type B is the rarest with a prevalence of 1%.
Case presentation
We present a case of a 35 neonate with birth weight 2130 g with type B atresia. In the prenatal imaging there were two findings associated with esophageal atresia (non-visualization of the stomach and polyhydramnios)
The neonate due to respiratory distress was intubated and admitted to NICU. The insertion of a feeding tube was unsuccessful and the XRAY showed a gasless abdomen and the catheter stopping at the third thoracic vertebra. The neonatal screening didn’t show any other congenital anomalies. The catheter remained to suction oropharyngeal secretions. The infant was NPO , with TPN.
A delayed primary repair of the esophagus was decided.. On the 64th day of life an open gastrostomy was performed and full enteral nutrition started in the 78 days of life.This delay was due to hospital acquired infections. In the 98 days of life a contrast study showed the upper part of the esophagus at the fifth thoracic vertebra and the lower part at the 9th thoracic vertebra. On the 140th day of life primary anastomosis was performed without tension. The postoperative evolution was uneventful, the neonate was intubated for 13 days and started oral feeding on the 14th day. Two months after surgery the esophagogram identified no leak , but stenosis which was treated with four endoscopic balloon dilation sessions with good results. The patient now is 1,5 years old, well thrived with no feeding problems.
Conclusion
Long gap esophageal atresia remains a challenge for pediatric surgeons. Delayed primary anastomosis at approximately 3 months of age , has been widely accepted as the preferred treatment option.