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Doval L, Rousseau V, Irtan S. Combined esophageal and duodenal atresia: A review of the literature from 1950 to 2020. Arch Pediatr 2023:S0929-693X(23)00083-0. [PMID: 37328325 DOI: 10.1016/j.arcped.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 01/23/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
The combination of duodenal atresia (DA) and esophageal atresia (EA) is very rare. With improvements in prenatal sonography and the use of fetal magnetic resonance imaging (MRI), these malformations can be diagnosed in a more accurate and timely manner; polyhydramnios remains the most common sign despite having a low specificity. The high rate of associated anomalies (in 85% of cases) can also impact neonatal management and increase the morbidity rate; thus, it is of paramount importance to look for every possible associated malformation, such as VACTERL and chromosomic anomalies. The surgical management of this combination of atresias is not well defined and changes according to the patient's clinical status, the type of EA, and the other associated malformations. Management ranges from a primary approach for one of the atresias with delayed correction of the other (56.8%) to a simultaneous repair of both atresias (33.8%) with or without gastrostomy, or total abstention (9.4%). We suggest that a simultaneous approach can be safely performed on patients in good physical condition, with a birth weight over 1500 g, and with no major respiratory distress; this method begins by closing the tracheoesophageal fistula to protect the lung and then repairing the DA. The mortality rate has decreased over the years, dropping from 71% before 1980 to 24% after 2001. In this review, we present the available evidence on these conditions, focusing mostly on the epidemiology, prenatal diagnosis, neonatal management strategies, and outcome, with the aim of determining how the different clinical features and surgical approaches may impact on morbidity and mortality.
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Affiliation(s)
- Lauren Doval
- Department of Visceral and Neonatal Pediatric Surgery, APHP Hôpital Armand Trousseau, Paris, France.
| | - Véronique Rousseau
- Department of Pediatric Surgery, APHP Hôpital Necker Enfants Malades, Paris, France
| | - Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, APHP Hôpital Armand Trousseau, Paris, France
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Awowole IO, Ugowe OJ, Ubom AE, Sowande OA. Isolated esophageal atresia misdiagnosed as twin-to-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:556-557. [PMID: 34532903 DOI: 10.1002/uog.24770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- I O Awowole
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ife, Osun State, Nigeria
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - O J Ugowe
- Department of Paediatrics and Child Health, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - A E Ubom
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - O A Sowande
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University, Ife, Osun State, Nigeria
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Lyttle BD, Liechty K, Corkum K, Galan H, Behrendt N, Zaretsky M, Bruny J, Derderian SC. In-utero gastric perforation from combined duodenal and esophageal atresia without consistent polyhydramnios. J Surg Case Rep 2021; 2021:rjab551. [PMID: 34987752 PMCID: PMC8714351 DOI: 10.1093/jscr/rjab551] [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: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
We present a case in which prenatal imaging at 21-weeks’ gestation suggested duodenal atresia with a double-bubble sign and enlarged stomach. Fetal magnetic resonance imaging findings demonstrated dilation of the stomach and proximal duodenum favoring duodenal atresia but no indications of esophageal atresia. Subsequent prenatal imaging demonstrated interval spontaneous decompression of the stomach without the development of polyhydramnios, obscuring the diagnosis. Postnatally, initial abdominal radiography showed a gasless abdomen, and an oral gastric tube could not pass the mid-esophagus, raising concern for pure esophageal atresia. Intraoperative findings were consistent with duodenal atresia, pure esophageal atresia and a gastric perforation due to a closed obstruction. In this case report, we review the prenatal diagnostic challenges and the limited literature pertaining to this unique pathology.
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Affiliation(s)
- Bailey D Lyttle
- Department of General Surgery, University of Colorado, Denver, CO, USA
| | - Kenneth Liechty
- Department of Pediatric Surgery, Children’s Hospital Colorado, Denver, CO, USA
| | - Kristine Corkum
- Department of Pediatric Surgery, Children’s Hospital Colorado, Denver, CO, USA
| | - Henry Galan
- Department of Maternal-Fetal Medicine, Children’s Hospital Colorado, Denver, CO, USA
| | - Nicholas Behrendt
- Department of Maternal-Fetal Medicine, Children’s Hospital Colorado, Denver, CO, USA
| | - Michael Zaretsky
- Department of Maternal-Fetal Medicine, Children’s Hospital Colorado, Denver, CO, USA
| | - Jennifer Bruny
- Department of Pediatric Surgery, Children’s Hospital Colorado, Denver, CO, USA
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Ivanitskaya O, Odegova N, Shchapov N, Tsayuk Y. Band neutrophil sign: A strong first-trimester ultrasound marker of combined duodenal and esophageal atresia. Prenat Diagn 2020:pd.5848. [PMID: 33068304 DOI: 10.1002/pd.5848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To reveal a first-trimester sonographic marker associated with combined duodenal and esophageal atresia (DA and EA). METHODS This retrospective study included four patients referred to our department in the first trimester due to fetal stomach anomaly. In the literature, we found 20 additional cases of combined DA and EA with four of them to be revealed at 12 weeks. RESULTS We present the largest for to date case series of combined DA and pure EA diagnosed in the first trimester including one with additional visualization of the distal esophageal pouch and its communication with the stomach. All our cases and four previously published reports (including two cases of DA and EA with tracheoesophageal fistula [TEF]) were characterized by the presence of "band neutrophil" sign-a symmetrical C-shaped loop in the fetal abdomen, occupying a central position close to the anterior abdominal wall. Similar findings could be seen also later in pregnancy, but they lack the same prognostic value. CONCLUSIONS Band neutrophil sign is a pathognomonic first-trimester ultrasound marker of combined DA and EA irrespective of the presence of TEF. Nevertheless, it should be further evaluated in prospective studies.
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Affiliation(s)
- Olga Ivanitskaya
- Moscow Regional Research Institute of Obstetrics and Gynecology, Medical Genetics Department, Moscow, Russia
| | - Natalia Odegova
- Moscow Regional Research Institute of Obstetrics and Gynecology, Medical Genetics Department, Moscow, Russia
| | - Nikolay Shchapov
- Moscow Regional Center for Maternity and Childhood Healthcare, Neonatal Surgery Department, Lyubertsy, Moscow Region, Russia
| | - Yulia Tsayuk
- Moscow Regional Research Institute of Obstetrics and Gynecology, Medical Genetics Department, Moscow, Russia
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Weissbach T, Kassif E, Kushnir A, Shust‐Barequet S, Leibovitch L, Eliasi E, Elkan‐Miller T, Zajicek M, Yinon Y, Weisz B. Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics. Prenat Diagn 2020; 40:1418-1425. [DOI: 10.1002/pd.5785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Elior Eliasi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Elkan‐Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Zajicek
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Townsend R, Khalil A. Fetal growth restriction in twins. Best Pract Res Clin Obstet Gynaecol 2018; 49:79-88. [DOI: 10.1016/j.bpobgyn.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/15/2018] [Indexed: 12/12/2022]
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