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Deguchi K, Kamiyama M, Masahata K, Nomura M, Watanabe M, Ueno T, Tazuke Y, Okuyama H. Balloon dilatation for congenital esophageal stenosis associated with esophageal atresia. Pediatr Surg Int 2024; 40:89. [PMID: 38517524 PMCID: PMC10959773 DOI: 10.1007/s00383-024-05652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Congenital esophageal stenosis (CES) associated with esophageal atresia (EA) is rare, and no standard treatment has been established. We reviewed cases of EA-associated CES to assess the clinical characteristics and treatment outcomes, especially the feasibility of endoscopic dilatation. METHODS We retrospectively examined patients with EA-associated CES. We also compared treatment outcomes of EA-associated CES with those of EA patients without CES who developed postoperative anastomotic stricture. RESULTS Among 44 patients with EA, ten had CES (23%). Postoperative complications were not significantly different between EA patients with CES and those without CES but with anastomotic stricture. All CES patients underwent balloon dilatation as initial treatment. Eight of nine patients (89%) were successfully treated by dilatation only, and one patient underwent surgical resection. The median number of balloon dilatations for CES was five (2-17), which was higher than that for anastomotic stricture in patients without CES (p = 0.012). Esophageal perforation occurred in five patients with CES (5/9, 56%) after dilatation, but all perforations were successfully managed conservatively with an uneventful post-dilatation course. CONCLUSIONS Twenty-three percent of patients with EA had CES. Although balloon dilatation for EA-associated CES required multiple treatments and carried a risk of perforation, balloon dilatation showed an 89% success rate and all perforations could be managed conservatively.
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Affiliation(s)
- Koichi Deguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Masafumi Kamiyama
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka, Japan.
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2
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Pirzirenli MG, Büyükkarabacak Y. Surgical esophageal diseases in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S108-S118. [PMID: 38584792 PMCID: PMC10995682 DOI: 10.5606/tgkdc.dergisi.2024.25770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 04/09/2024]
Abstract
Pediatric age esophageal diseases are rare and complex clinical conditions. Treatment options should be individually determined for the patient. The advances in the follow-up and treatment process is the most important reason for the increase in survival time, particularly for congenital pediatric surgical diseases. This study aimed to evaluate the general characteristics of pediatric surgical esophageal diseases in light of the literature.
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Affiliation(s)
| | - Yasemin Büyükkarabacak
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
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3
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Kim SH. Congenital esophageal stenosis caused by tracheobronchial remnants: A case report. Radiol Case Rep 2023; 18:3672-3674. [PMID: 37601120 PMCID: PMC10432260 DOI: 10.1016/j.radcr.2023.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/18/2023] [Accepted: 07/23/2023] [Indexed: 08/22/2023] Open
Abstract
Congenital esophageal stenosis caused by tracheobronchial remnants is a rare anomaly in infants and children that results in dysphagia and recurrent pneumonia. An accurate diagnosis is needed because this anomaly does not respond well to instrumental dilatation, such as bougienage and balloon dilatation, and requires surgical resection. Herein, I report a case of congenital esophageal stenosis caused by tracheobronchial remnants with characteristic imaging findings.
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Affiliation(s)
- Soung Hee Kim
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea
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4
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Hemi FK, Jozef A, Taishori N, Ismail N, Ali W, Omran A. Proximal congenital esophageal stenosis associated with tracheo-esophageal fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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5
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Gao Z, Wang L, Liu H, Zhang X. Congenital esophageal stenosis caused by tracheobronchial remnants: a case report. J Int Med Res 2022; 50:3000605221132704. [PMID: 36271607 PMCID: PMC9597040 DOI: 10.1177/03000605221132704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of congenital esophageal stenosis in which the patient underwent ineffective balloon dilatation twice and eventually required surgery. The case was initially misdiagnosed as achalasia. Pathological findings revealed tracheobronchial remnants (TBRs) in the muscular layer of strictured esophageal tissue. Most TBR strictures are located in the middle and lower thirds of the esophagus. Esophagography is the main examination method for esophageal stricture, and the appearance of the "rat tail sign" is a key diagnostic indicator. Endoscopic ultrasonography can reveal hypoechoic cartilaginous structures. The gold standards for TBR treatment include esophageal stricture resection, end-to-end esophageal anastomosis, and the construction of structures to prevent reflux. At present, endoscopic longitudinal resection and transverse anastomosis of the anterior esophageal wall with partial cartilage resection without pyloroplasty are novel and practical TBR procedures. To avoid further complications, patients with congenital esophageal stenosis should be promptly treated surgically if balloon dilatation is ineffective.
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Affiliation(s)
- Zhihong Gao
- Health Management Center, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Lingyan Wang
- Department of Pathology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China
| | - Xia Zhang
- Department of Radiology, Hebei Children’s Hospital,
Shijiazhuang, Hebei, China,Xia Zhang, No. 133, Jianhua South Street,
Yuhua District, Shijiazhuang City, Hebei Province, 050031, P. R. China.
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6
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Tanimoto T, Noda T, Imaji R, Nouso H. A case of esophageal atresia with the bronchial-like lower esophagus which originates from the left lower lobe bronchus. Surg Case Rep 2022; 8:156. [PMID: 35969287 PMCID: PMC9378802 DOI: 10.1186/s40792-022-01513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Esophageal atresia with or without a trachea–esophageal fistula occurs due to the failure of separation or incomplete development of the foregut. Therefore, esophageal atresia is often associated with various forms of tracheobronchial anomalies. We report an extremely rare case of esophageal atresia.
Case presentation A female infant was born at 37 weeks of gestation and weighed 2596 g. A diagnosis of esophageal atresia and total anomalous pulmonary vein return type III were confirmed. The infant had respiratory distress that required tracheal intubation and ventilatory support soon after birth. Temporary banding of the gastroesophageal junction and gastrostomy were performed on the second day of life. However, her respiratory condition deteriorated due to atelectasis of the left lung and compensatory hyperinflation of the right lung. Preoperative examinations showed the unilobe and atelectatic left lung. The trachea was trifurcated in three directions, and the branch that was expected to be the left main bronchus was blind-ended. The dorsal branch was cartilaginous and bifurcated into the left lower lobe bronchus and lower esophagus approximately 1 cm distal from the tracheal trifurcation. The cartilaginous tissue continued to the lower esophagus. The diagnosis of esophageal atresia with the lower esophagus which originated from the left lower lobe bronchus was made. Esophageal atresia repair was performed when the patient was 4 months of age. The esophagus was dissected distally to the bifurcation of the left lower lobe bronchus via right thoracotomy. The lower esophagus was bronchial-like in appearance, transitioning to the normal esophageal wall approximately 7 mm distal to the transected edge. The cartilage tissue was completely resected during surgery, and a primary end-to-end anastomosis of the esophagus was successfully performed. Histopathological findings revealed that the extracted specimen was surrounded by tracheal cartilage and that the inner surface was covered by stratified squamous epithelium that originated from the esophagus. Conclusions In cases of esophageal atresia with an atypical clinical presentation, there may be unique structural abnormalities of the foregut. We emphasize the importance of a preoperative surgical planning since an inadequate operation can lead to fatal complications.
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7
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Management and clinical outcomes of congenital esophageal stenosis in pediatric patients: Experience of a tertiary referral center. J Pediatr Surg 2022; 57:518-525. [PMID: 34229876 DOI: 10.1016/j.jpedsurg.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to retrospectively investigate congenital esophageal stenosis (CES) cases managed at our institution using a non-aggressive strategy based on a step-up approach from esophageal balloon dilatations to surgery. METHODS Patients' charts with CES managed in a tertiary pediatric surgery department were retrospectively evaluated. Demographic characteristics, clinical features, pH-monitoring, imaging, and esophagoscopy results were recorded together with their treatments and outcomes. RESULTS Nineteen patients, confirmed with radiologic and endoscopic investigations, were managed. Complete symptom resolution was achieved in 14 patients by a median of five (2-15) recurrent esophageal balloon dilatations lasting for 7.5 (2-108) months. Two more patients, after 7 and 15 dilatations, had mild dysphagia, not interfering with their daily living. One patient, in whom the initial dilatation attempt with 3 atm was unsuccessful, and two patients with persistent symptoms and growth retardation despite ongoing dilatation treatment, underwent surgery. After 48 (12-132) months of follow-up, 17 patients were symptom-free. CONCLUSION Conservative treatment with esophageal balloon dilatations is an efficient and reliable modality that can be used as a first-line treatment in CES. Surgical treatment option should be used when dilatation attempt is unsuccessful, or symptoms and growth retardation persist despite dilatation treatment.
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8
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Ludwig K, De Bartolo D, Salerno A, Ingravallo G, Cazzato G, Giacometti C, Dall’Igna P. Congenital anomalies of the tubular gastrointestinal tract. Pathologica 2022; 114:40-54. [PMID: 35212315 PMCID: PMC9040549 DOI: 10.32074/1591-951x-553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 02/08/2023] Open
Abstract
Congenital anomalies of the tubular gastrointestinal tract are an important cause of morbidity not only in infants, but also in children and adults. The gastrointestinal (GI) tract, composed of all three primitive germ layers, develops early during embryogenesis. Two major steps in its development are the formation of the gut tube (giving rise to the foregut, the midgut and the hindgut), and the formation of individual organs with specialized cell types. Formation of an intact and functioning GI tract is under strict control from various molecular pathways. Disruption of any of these crucial mechanisms involved in the cell-fate decision along the dorsoventral, anteroposterior, left-right and radial axes, can lead to numerous congenital anomalies, most of which occur and present in infancy. However, they may run undetected during childhood. Therapy is surgical, which in some cases must be performed urgently, and prognosis depends on early diagnosis and suitable treatment. A precise pathologic macroscopic or microscopic diagnosis is important, not only for the immediate treatment and management of affected individuals, but also for future counselling of the affected individual and their family. This is even more true in cases of multiple anomalies or syndromic patterns. We discuss some of the more frequent or clinically important congenital anomalies of the tubular GI, including atresia's, duplications, intestinal malrotation, Meckel's diverticulum and Hirschsprung's Disease.
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Affiliation(s)
- Katrhin Ludwig
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Debora De Bartolo
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angela Salerno
- Department of Oncology, Anatomic and Histologic Pathology and Cytodiagnostics, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ingravallo
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Cinzia Giacometti
- Department of Services, Pathology Unit, ULSS 6 “Euganea”, Camposampiero, Italy
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
- Correspondence Patrizia Dall’Igna Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale, Ospedale Pediatrico Giovanni XXIII, via Giovanni Amendola 207, 70126 Bari, Italy E-mail:
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9
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Multiple Congenital Esophageal Stenoses in a 15-Month-old Child. J Pediatr Gastroenterol Nutr 2020; 71:e97. [PMID: 32404751 DOI: 10.1097/mpg.0000000000002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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10
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Brzački V, Mladenović B, Jeremić L, Živanović D, Govedarović N, Dimić D, Golubović M, Stoičkov V. Congenital esophageal stenosis: a rare malformation of the foregut. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:535-547. [PMID: 31849372 PMCID: PMC6892676 DOI: 10.18999/nagjms.81.4.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022]
Abstract
Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.
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Affiliation(s)
- Vesna Brzački
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Bojan Mladenović
- Gastroenterology and Hepatology Clinic, Clinical Center Niš, Niš, Serbia
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Ljiljana Jeremić
- General Surgery Clinic, Clinical Center Niš, Niš, Serbia
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Dragoljub Živanović
- Department of Surgery, Faculty of Medicine, University of Niš, Niš, Serbia
- Pediatric Surgery and Orthopedic Clinic, Clinical Center Niš, Niš, Serbia
| | - Nenad Govedarović
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Hematology and Clinical Immunology Clinic, Clinical Center Niš, Niš, Serbia
| | - Dragan Dimić
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Endocrinology Clinic, Clinical Center Niš, Niš, Serbia
| | - Mladjan Golubović
- Anesthesiology and Reanimation Center, Clinical Center Niš, Niš, Serbia
| | - Viktor Stoičkov
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Treatment and Rehabilitation "Niška Banja," Niš, Serbia
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11
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Sundararajan P, Natarajan S, Thialagam K K. Congenital esophageal stenosis presenting in an 8-year-old child. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2018-000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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12
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Suzuhigashi M, Kaji T, Noguchi H, Muto M, Goto M, Mukai M, Nakame K, Kawano T, Yamada W, Yamada K, Onishi S, Ieiri S. Current characteristics and management of congenital esophageal stenosis: 40 consecutive cases from a multicenter study in the Kyushu area of Japan. Pediatr Surg Int 2017; 33:1035-1040. [PMID: 28801834 DOI: 10.1007/s00383-017-4133-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital esophageal stenosis (CES) is rare, and the available clinical data are limited. We explored the current diagnosis, treatment and outcomes of CES. METHODS A questionnaire survey was performed using medical records at pediatric surgical centers in the Kyushu area. RESULTS Over 10 years, 40 patients (24 males) had CES. The incidence of associated anomalies was 52.5% (21/40), and that of esophageal atresia was 20.0% (8/40). The mean age at the diagnosis was 12.0 months (range, 1 day-8.8 years). Seven (17.5%) patients were diagnosed in the neonatal period. Ten (25.0%) developed CES due to tracheobronchial remnants, 27 (67.5%) due to fibromuscular stenosis (FMS) and 1 (2.5%) due to membranous stenosis + FMS. Thirty-six (90.0%) were treated by balloon dilatation (mean, 3 times; range, 1-20). Perforation at dilatation occurred in 7 (17.5%) patients, and all were diagnosed with FMS. Eighteen (45.0%) patients underwent radical operation (3 primary, 15 secondary to dilatation). CONCLUSIONS Our study clarified the characteristics and outcomes of CES, including neonatal diagnoses. CES occurred in 1 in every 33,000 births in the Kyushu area. Careful attention should be paid, even in cases of dilatation for FMS. CES requires long-term follow-up for symptom persistence after adequate and repeated treatment.
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Affiliation(s)
- Masaya Suzuhigashi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.,Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroyuki Noguchi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Michiko Goto
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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13
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Kim SH, Kim HY, Jung SE, Lee SC, Park KW. Clinical Study of Congenital Esophageal Stenosis: Comparison according to Association of Esophageal Atresia and Tracheoesophageal Fistula. Pediatr Gastroenterol Hepatol Nutr 2017; 20:79-86. [PMID: 28730131 PMCID: PMC5517383 DOI: 10.5223/pghn.2017.20.2.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Congenital esophageal atresia (CES) is a rare congenital disease. The severity of symptoms is variable; thus, diagnosis is difficult and tends to be delayed. CES is frequently accompanied by esophageal atresia (EA) with/without tracheoesophageal fistula (TEF). We investigated the characteristics of CES by reviewing our experience with CES patients and researched the differences between CES with EA-TEF and isolated CES. METHODS A total of 31 patients underwent operations for CES were reviewed retrospectively. The patients were divided into two groups according to the association with EA-TEF, and compared the differences. RESULTS Sixteen boys and 15 girls were included. The mean age at symptom onset was 8 months old, and the mean age at diagnosis was 21 months old. Nine patients with EA-TEF were included group A, whereas the other 22 patients were assigned to group B. There were no differences in sex, gestational age, associated anomalies and pathologic results between the groups. In group A, the age at diagnosis and age at surgery were younger than in group B despite the age at symptom occurrence being similar. Postoperative complications occurred only in group A. CONCLUSION In this study, symptoms occurred during the weaning period, and vomiting was the most frequent symptom. CES patients with EA-TEF tended to be diagnosed and treated earlier despite the age at symptom occurrence being similar. CES patients with EA-TEF had more postoperative complications; therefore, greater attention should be paid during the postoperative period.
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Affiliation(s)
- Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Seong-Cheol Lee
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kwi-Won Park
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
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14
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Abstract
Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.
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Affiliation(s)
- A Francois Trappey
- David Grant Medical Center, Travis Air Force Base, California; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, California
| | - Shinjiro Hirose
- Department of Surgery, UC Davis Medical Center, Sacramento, California; Division of Pediatric General, Thoracic, and Fetal Surgery, UC Davis Medical Center, Sacramento, California; Shriners Hospitals for Children-Northern California, 2425 Stockton Blvd, Sacramento, California 95817.
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15
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An Unusual Presentation of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants in a Newborn Prenatally Diagnosed with Duodenal Atresia. J Belg Soc Radiol 2015; 99:43-46. [PMID: 30039104 PMCID: PMC6032603 DOI: 10.5334/jbr-btr.881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Congenital esophageal stenosis due to tracheobronchial remnants is defined as an
intrinsic stenosis of the esophagus caused by congenital architectural
abnormalities of the esophageal wall. Although CES is present at birth, it
remains asymptomatic till at the age of 4–10 months, when solid food is
introduced. Here we present a case diagnosed in the neonatal period after urgent
cesarean for an associated duodenal atresia complicated with perforation. There
is a mutual association between duodenal atresia and congenital esophageal
stenosis. When duodenal atresia is diagnosed, think of possible associated
esophageal abnormalities, especially when duodenal atresia is complicated by
gastric perforation prenatally.
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16
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McCann F, Michaud L, Aspirot A, Levesque D, Gottrand F, Faure C. Congenital esophageal stenosis associated with esophageal atresia. Dis Esophagus 2015; 28:211-5. [PMID: 24446921 DOI: 10.1111/dote.12176] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital esophageal stenosis (CES) is a rare clinical condition but is frequently associated with esophageal atresia (EA). The aim of this study is to report the diagnosis, management, and outcome of CES associated with EA. Medical charts of CES-EA patients from Lille University Hospital, Sainte-Justine Hospital, and Montreal Children's Hospital were retrospectively reviewed. Seventeen patients (13 boys) were included. The incidence of CES in patients with EA was 3.6%. Fifteen patients had a type C EA, one had a type A EA, and one had an isolated tracheoesophageal fistula. Seven patients had associated additional malformations. The mean age at diagnosis was 11.6 months. All but two patients had non-specific symptoms such as regurgitations or dysphagia. One CES was diagnosed at the time of surgical repair of EA. In 12 patients, CES was suspected based on abnormal barium swallow. In the remaining four, the diagnostic was confirmed by esophagoscopy. Eleven patients were treated by dilation only (1-3 dilations/patient). Six patients underwent surgery (resection and anastomosis) because of failure of attempted dilations (1-7 dilations/patient). Esophageal perforation was encountered in three patients (18%). Three patients had histologically proven tracheobronchial remnants. CES associated with EA is frequent. A high index of suspicion for CES must remain in the presence of EA. Dilatation may be effective to treat some of them, but perforation is frequent. Surgery may be required, especially in CES secondary to ectopic tracheobronchial remnants.
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Affiliation(s)
- F McCann
- Esophageal Atresia Clinic, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Canada
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17
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Rebelo PG, Ormonde JVC, Ormonde Filho JBC. Congenital esophageal stenosis owing to tracheobronchial remnants. REVISTA PAULISTA DE PEDIATRIA 2014; 31:406-10. [PMID: 24142326 PMCID: PMC4182969 DOI: 10.1590/s0103-05822013000300020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal
stenosis due to tracheobronchial remnants, since its treatment differs from
other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial
remnants, whose definitive diagnosis was made by histopathology. Except for
the last case, in which a concomitant anti-reflux surgery was not performed,
all had a favorable outcome after resection and anastomosis of the
esophagus. COMMENTS The congenital esophageal stenosis is an intrinsic narrowing of the
organâ€(tm)s wall associated with its structural malformation. The condition
can be caused by tracheobronchial remnants, fibromuscular stenosis or
membranous diaphragm and the first symptom is dysphagia after the
introduction of solid food in the diet. The first-choice treatment to
tracheobronchial remnants cases is the surgical resection and end-to-end
anastomosis of the esophagus.
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18
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Thoracoscopic and laparoscopic esophagoplasty for congenital esophageal stenosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Tracheobronchial remnants: a rare congenital anomaly. Clin Gastroenterol Hepatol 2011; 9:A26. [PMID: 21185395 DOI: 10.1016/j.cgh.2010.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 12/06/2010] [Accepted: 12/13/2010] [Indexed: 02/07/2023]
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20
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Longcroft-Wheaton G, Ellis R, Somers S. Dysphagia in a 30-year-old woman: too old for a congenital abnormality? Br J Hosp Med (Lond) 2010; 71:170-1. [PMID: 20220726 DOI: 10.12968/hmed.2010.71.3.46984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features. Pediatr Radiol 2010; 40:1353-9. [PMID: 20221592 DOI: 10.1007/s00247-010-1603-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/24/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. OBJECTIVE To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. MATERIALS AND METHODS We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. RESULTS CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. CONCLUSION Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.
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22
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Serrao E, Santos A, Gaivao A, Tavares A, Ferreira S. Congenital esophageal stenosis: a rare case of dysphagia. J Radiol Case Rep 2010; 4:8-14. [PMID: 22470735 DOI: 10.3941/jrcr.v4i6.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Congenital esophageal stenosis (CES) is a rare anomaly, resulting from incomplete separation of the respiratory tract from the primitive foregut at the 25th day of life. First clinical signs are abnormalities of the swallowing mechanism caused by the intrinsic narrowing of the esophagus. Diagnosis is usually delayed, requiring an accurate history and high level of suspicion, alongside with an esophagogram. Definite diagnosis is only confirmed by histological examination. Treatment usually involves surgery, depending on the severity, location and type of stenosis. We report the case of an 18 months old toddler diagnosed with CES. The characteristic radiographic and CT features are presented as well as the histology.
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Affiliation(s)
- Eva Serrao
- Department of Imaging, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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23
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Oesophageal tracheobronchial remnants. ACTA ACUST UNITED AC 2008; 32:779-81. [PMID: 18538969 DOI: 10.1016/j.gcb.2008.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/01/2008] [Indexed: 02/07/2023]
Abstract
SUMMARY Congenital oesophageal stenosis due to tracheobronchial remnants is a very rare condition characterized by the presence of tracheobronchial tissue in the oesophageal wall. The most common symptoms are dysphagia, regurgitation and hypersalivation. These usually appear in early infancy when solid food is introduced into the diet. Clinical diagnosis is difficult. Conventional radiology shows a dilated oesophagus without peristalsis, incomplete expansion of the gastro-oesophageal transition zone and delayed oesophageal emptying. Lesions suggesting oesophagitis may be present at endoscopy but pH-metry may be normal. The combination of stenosis with or without oesophagitis with normal pH-metry suggests that the patient's symptoms may be due to factors other than intraluminal and that further investigation is needed. The treatment of this condition requires surgical resection of the stenosis with little morbidity or mortality. The presence of tracheobronchial remnants is confirmed upon histopathological examination of the resected bowel segment.
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Saito T, Ise K, Kawahara Y, Yamashita M, Shimizu H, Suzuki H, Gotoh M. Congenital esophageal stenosis because of tracheobronchial remnant and treated by circular myectomy: a case report. J Pediatr Surg 2008; 43:583-5. [PMID: 18358309 DOI: 10.1016/j.jpedsurg.2007.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 11/10/2007] [Accepted: 11/12/2007] [Indexed: 01/25/2023]
Abstract
Congenital esophageal stenosis (CES) is a rare anomaly, and appropriate management is not well established. We performed myectomy of the esophageal wall in a child with critical esophageal stenosis caused by tracheobronchial remnant (TBR). An 18-month-old boy was admitted to our hospital having frequent vomiting and failure to thrive. Esophagography and esophagoscopy showed abrupt stenosis at the lower esophageal wall. Balloon dilatation was performed but was ineffective. Surgery was performed under a diagnosis of CES because of TBR. Cartilage was palpable in the stenotic esophageal wall, and extirpation of the muscular layer of the stenotic portion was performed, leaving the mucosal layer intact. The muscular layer was closed loosely using interrupted 5-0 absorbable sutures to match the oral and anal sides together. Postoperatively, the esophageal passage was improved to the point that the patient was able to take solid foods without vomiting. This successful outcome suggests that circular myectomy of the TBR is worth recommending as a surgical procedure for short segment and stenosis of patients with CES because of TBR.
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Affiliation(s)
- Takahiro Saito
- First Department of Surgery, Fukushima Medical University, Fukushima-Shi, Fukushima 960-1295, Japan
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25
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Fox E, Lee K, Lamb CR, Rest J, Baines SJ, Brockman D. Congenital oesophageal stricture in a Japanese shiba inu. J Small Anim Pract 2007; 48:709-12. [PMID: 17725590 DOI: 10.1111/j.1748-5827.2007.00361.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An 11-week-old, female, Japanese shiba inu, weighing 1.3 kg, was presented with a history of intermittent regurgitation since birth. An oesophagram showed a partial obstruction of the caudal cervical oesophagus associated with a narrow, transverse tissue band. Following surgical resection, the regurgitation resolved and the dog attained a normal bodyweight. Histological examination revealed focally hyperplastic epithelium with dense fibrous underlying connective tissue forming the band. The diagnosis was a congenital oesophageal stricture.
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Affiliation(s)
- E Fox
- Queen Mother Hospital for Animals, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Herts AL9 7TA, UK
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26
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Ibrahim AHM, Al Malki TA, Hamza AF, Bahnassy AF. Congenital esophageal stenosis associated with esophageal atresia: new concepts. Pediatr Surg Int 2007; 23:533-7. [PMID: 17437115 DOI: 10.1007/s00383-007-1927-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
Congenital esophageal stenosis (CES) is suspected by a fixed intrinsic narrowing of the esophagus that affects the normal swallowing mechanism. The diagnosis is only confirmed by histopathologic picture, which may show fibromuscular disease (FMD) or tracheobronchial remnants (TBR). The latter involves ciliated pseudo stratified columnar epithelium, seromucous glands or cartilage each alone or in combination. The aim of this study is to document the usefulness of histologic picture of surgical specimens obtained from the lower esophageal pouch (LEP) during primary repair in detecting cases of CES associated with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF). Over an 8-year period, 57 consecutive cases operated upon for EA with or without TEF were subjected for histologic examination of surgical specimens obtained from the tip of the LEP. Cases that histologically showed FMD or TBR were included. The usefulness of this histologic picture as a diagnostic and therapeutic aid is assessed. Methods of treatment and outcome were also reviewed. Eight patients out of 57 (14%) had a histologic picture suggestive of CES, two with FMD, four with TBR without cartilage and two with cartilage. Out of 57 patients, 23 developed strictures, six of them had positive biopsies suggestive of CES. One patient with TBR without cartilage did not have stricture. Another case of pure atresia had LEP resection and gastric pull up showed cartilage involving the whole lower esophagus. Excluding the case of pure EA with gastric pull up, all patients suffered from feeding problems and recurrent aspiration. Fluoroscopic barium studies showed late onset minor dysmotility in five patients and late onset major dysmotility in two. All cases studied showed significant gastro-esophageal reflux (GER). Stricture was seen at the anastomotic site extending distally in the two fibromuscular cases and one case with cartilage, at the anastomotic site in three cases with TBR without cartilage. Anti reflux surgical procedures were performed in four patients without benefit in two patients with major dysmotility. Dilatation was successful in the three patients with TBR without cartilage. One patient with cartilage had resection of the anastomotic site and required frequent dilatations and is now doing well. A case of FMD did not improve after frequent dilatations and myotomy together with Nissen's fundoplication and required resection while the other case of FMD responded partially to dilatations. Cartilage in cases of CES requires surgical resection. Those with TBR without cartilage may not develop stricture. If stricture develops, it responds well to dilatation and patients have good clinical outcomes. Unlike isolated CES, GER is a significant feature in CES with EA. Anti reflux procedures should be avoided before definitive surgery for the stricture and if necessary a partial wrap with gastrostomy is recommended. CES should be considered in the etiology of anastomotic stricture. Taking a surgical specimen routinely from the tip of the LEP during primary esophageal repair for histologic studies is highly recommended.
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Affiliation(s)
- Ashraf H M Ibrahim
- Armed Forces Hospital, Southern Region, King Faisal Military City, P. O. Box: 5062, Khamis Mushait, Kingdom of Saudi Arabia.
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Prost F, Nedelcu C, Hélardot P, Montagne JP. Difficultés d'alimentation après une intervention pour atrésie de l'œsophage. Arch Pediatr 2007; 14:285-6. [PMID: 17067790 DOI: 10.1016/j.arcped.2006.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 09/18/2006] [Indexed: 11/29/2022]
Affiliation(s)
- F Prost
- Service de radiologie pédiatrique, Assistance publique-Hôpitaux de Paris, hôpital d'enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France
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28
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Ouanes I, Mekki M, Jouini R, Belghith M, Sahnoun L, Zakhama A, Maazoun K, Golli M, Krichène I, Nouri A. Sténose congénitale de l'œsophage par hétérotopie trachéobronchique : à propos de 2 cas et revue de littérature. Arch Pediatr 2006; 13:1043-6. [PMID: 16713210 DOI: 10.1016/j.arcped.2006.03.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 03/14/2006] [Indexed: 11/17/2022]
Abstract
Congenital esophageal stenosis due to tracheobronchial remnants is a rare malformation whose diagnosis may be difficult. It is characterised by the abnormal presence of congenital tissue of tracheal origin in the esophageal wall, which is responsible for the narrowing of the esophagus. We report 2 cases whose treatment was surgical after failure of esophageal dilations. The presence of tracheal-bronchial tissue was confirmed by histological examination of the operative piece. Outcome was favourable and the final result was excellent. Recently, endoscopic ultrasonography has been proved useful in the diagnosis of congenital esophageal stenosis due to tracheobronchial remnants by showing the presence of cartilage, which explains the failure of dilation. The high rate of perforation in these cases is due to brutal fragmentation of the cartilaginous rings. Surgical resection of esophageal stenosis with the tracheobronchial tissue appears the only treatment susceptible to completely suppress the stenosis and its consequences.
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Affiliation(s)
- I Ouanes
- Service de chirurgie pédiatrique, CHU Fattouma-Bourguiba, 5000 Monastir, Tunisie
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Diagnosis | Esophageal stenosis with a secondary fistula. Lab Anim (NY) 2006. [DOI: 10.1038/laban0106-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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