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Hirotani T, Tamura R, Ando M, Okajima H. External Esophageal Stenting Technique in Palliation for Tracheal Agenesis in a Case of Esophageal Lung: A Lesson Learned from the Experience for Tracheomalacia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1907. [PMID: 38136109 PMCID: PMC10741666 DOI: 10.3390/children10121907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Tracheal agenesis (TA) is a rare congenital anomaly with an incidence of 1 per 50,000 newborns. It appears at birth with severe respiratory distress, cyanosis, and inaudible crying. Prompt esophageal intubation and long-term management of the esophageal airway are essential to overcome this catastrophic condition. In the long-term management, external stenting of the esophageal airway has been reported as promising to support the fragile esophageal wall; this technique was taken from the surgery for tracheomalacia. We experienced a case of an infant with tracheal agenesis whose respiratory status was stabilized after external esophageal stenting. The stenting was performed based on a lesson learned in the extensive experience in the surgical treatment for tracheomalacia, and the surgical techniques for successful stenting are herein described.
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Affiliation(s)
- Taichi Hirotani
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Ryo Tamura
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Makoto Ando
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan
- Advanced Pediatric Surgical Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan;
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2
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Akhter AP, Donn SM. The challenging airway: Tracheal agenesis in the newborn. J Neonatal Perinatal Med 2021; 15:663-665. [PMID: 34974441 DOI: 10.3233/npm-210846] [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: 11/15/2022]
Abstract
A preterm female presented with severe respiratory distress in the delivery room and was found to have tracheal agenesis with a tracheoesophageal fistula and a congenital heart defect. Tracheal agenesis is uncommon and is often associated with other congenital abnormalities. Although there are surgical options for repair, mortality remains high.
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Affiliation(s)
- A P Akhter
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan USA
| | - S M Donn
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan USA
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3
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Iinuma Y, Uchiyama M, Okuyama N, Murata H, Kuwabara S, Hirayama Y, Komatsuzaki N, Nakaya K, Sugai Y, Taki S, Nitta K. The long-term outcome of tracheal agenesis following reconstruction of the airway and alimentary tract. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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4
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Qi Y, Huo H, Ma M, Wu J, Li X, Liu B. Prenatal diagnosis of pulmonary artery sling associated with tracheal agenesis: A case report. Echocardiography 2020; 37:2148-2151. [PMID: 33145790 DOI: 10.1111/echo.14875] [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: 07/11/2020] [Revised: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery sling (PAS) and tracheal agenesis (TA) are rare diseases, and most cases of PAS are associated with tracheal bronchial malformations. However, PAS associated with TA is yet to be reported. We report a case of PAS with TA diagnosed prenatally. Due to the extremely low incidence, physicians do not have sufficient understanding of these diseases and it is challenging to diagnose these diseases by prenatal ultrasound, with high rates of misdiagnosis. Prenatal examination of the pulmonary artery branches, trachea, and esophagus is useful; therefore, improving the accuracy of prenatal diagnosis will help in perinatal management and counseling.
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Affiliation(s)
- Yanhua Qi
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanhuan Huo
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miaoyan Ma
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinfang Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopeng Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baomin Liu
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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5
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Tracheal agenesis: A rare cause of inability to secure the airways in a newborn. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Straughan AJ, Mulcahy CF, Sandler AD, Bauman NM, Steinhorn D, Gitman L. Tracheal Agenesis: Vertical Division of the Native Esophagus - A Novel Surgical Approach and Review of the Literature. Ann Otol Rhinol Laryngol 2020; 130:547-562. [PMID: 33030043 DOI: 10.1177/0003489420962124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. METHODS Case report and literature review. RESULTS A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. CONCLUSION We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.
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Affiliation(s)
- Alexander J Straughan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | - Lyuba Gitman
- Children's National Health System, Washington, DC, USA
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7
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Saadi S, Ben Abdeljelil N, Ben Salem A, Chioukh FZ, Haj Salem N. Tracheal agenesis clinical presentation in a preterm infant: Prenatal MRI difficulties and autopsy findings. Radiol Case Rep 2020; 15:1604-1608. [PMID: 32685079 PMCID: PMC7355954 DOI: 10.1016/j.radcr.2020.06.047] [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: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
We describe, the clinical presentation of a rare case of Tracheal Agenesis in a preterm infant and we highlight magnetic imaging resonance (MRI) and autopsy findings to better characterize this anomaly. A 30-year-old female presented for acute polyhydramnios at 30 weeks gestation of a male foetus. Prenatal MRI was performed and excluded this diagnosis. After delivery, the neonate presented a respiratory distress. The laryngoscopy control of tube position concluded to an esophageal intubation. A second reading of antenatal MRI was made. An autopsy was performed. The internal examination of the organs revealed broncho-oesophageal fistula. The upper airways were obstructed at the larynx. Fetal MRI should be interpreted with caution when Tracheal Agenesis is highly suspected.
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Affiliation(s)
- Said Saadi
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Forensic Medicine, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Pathology, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
| | - Amina Ben Salem
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Medical Imaging B, Maternity and Neonatal Teaching Center, 5000, Monastir, Tunisia
| | - Fatma Zohra Chioukh
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Intensive Care and Neonatal Medicine, Maternity and Neonatal Teaching Center, 5000, Monastir, Tunisia
| | - Nidhal Haj Salem
- Faculty of Medicine, University of Monastir, Tunisia.,Department of Forensic Medicine, Fattouma Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
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8
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Krishnamurthy K, Kochiyil J, Poppiti RJ. Tracheal agenesis with esophageal atresia: an autopsy case report of a variant incompatible with life. Fetal Pediatr Pathol 2020; 39:45-50. [PMID: 31314628 DOI: 10.1080/15513815.2019.1627628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Tracheal agenesis/atresia (TA) presents with respiratory distress at birth and subsequent difficulty in endotracheal intubation. The antenatal course is complicated by polyhydramnios and premature labor. Case report: We present a newborn baby boy with respiratory distress and unsuccessful intubation. Postmortem neck dissection revealed tracheal atresia with esophageal atresia and high tracheoesophageal fistula. Conclusion: In this variant of tracheal atresia, the coexistent esophageal atresia precluded the establishment of a functional air passage. This variant that does not fall into the any of the described categories in accepted classification systems. The lack of any distal communication makes this case inoperable and fatal.
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Affiliation(s)
- Kritika Krishnamurthy
- Arkadi M. Rywlin M.D., Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Robert J Poppiti
- Arkadi M. Rywlin M.D., Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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9
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Densmore JC, Oldham KT, Dominguez KM, Berdan ER, McCormick ME, Beste DJ, Amos LB, Lang CA, Woods RK, Kouretas PC, Mitchell ME. Neonatal esophageal trachealization and esophagocarinoplasty in the treatment of flow-limited Floyd II tracheal agenesis. J Thorac Cardiovasc Surg 2019; 153:e121-e125. [PMID: 28526113 DOI: 10.1016/j.jtcvs.2017.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
- John C Densmore
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis.
| | - Keith T Oldham
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Children's Research Institute, Milwaukee, Wis
| | | | - Elizabeth R Berdan
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E McCormick
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - David J Beste
- Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wis
| | - Louella B Amos
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Cecilia A Lang
- Division of Pediatric Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Ronald K Woods
- Children's Research Institute, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Peter C Kouretas
- Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wis; Clinical and Translational Sciences Institute of Southeast Wisconsin, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis
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10
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Naina P, John M, Kathar MA, Kumar M. Tracheal agenesis in a new born: lessons learnt. BMJ Case Rep 2018. [PMID: 29914900 DOI: 10.1136/bcr-2017-224003.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mohamed Abdul Kathar
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
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11
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Naina P, John M, Kathar MA, Kumar M. Tracheal agenesis in a new born: lessons learnt. BMJ Case Rep 2018; 2018:bcr-2017-224003. [PMID: 29914900 DOI: 10.1136/bcr-2017-224003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mohamed Abdul Kathar
- Department of ENT, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
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12
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Sattler C, Chiao F, Stein D, Murphy D. Life-Saving Esophageal Intubation in Neonate With Undiagnosed Tracheal Agenesis: A Case Report. ACTA ACUST UNITED AC 2017; 9:31-34. [PMID: 28410262 DOI: 10.1213/xaa.0000000000000518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 3-day-old, 2.2-kg former 34-week premature infant with imperforate anus required loop ileostomy surgery. At delivery, the child had respiratory distress. Endotracheal intubation was "confirmed" by detection of exhaled carbon dioxide with a Pedi-Cap (Covidien, Dublin, Ireland) and subsequent chest x-ray. On arrival to the operating room, the pulse oximeter reading was 100% despite a large leak around the endotracheal tube and high-airway pressures. Packing the throat reduced the leak and increased the tidal volume. Intraoperative bronchospasm occurred during the surgery. On postoperative day 1, fiberoptic examination by an otolaryngologist revealed esophageal intubation and the absence of laryngeal opening. Subsequent computed tomography scan revealed Floyd type II tracheal agenesis. To our knowledge, this is the only case of tracheal agenesis diagnosed after a non-airway related procedure. We discussed how the diagnosis was missed.
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Affiliation(s)
- Christopher Sattler
- From the Department of Anesthesiology, NewYork Presbyterian Hospital-Weill Cornell Medical College, New York, New York
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13
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Agarwal A, Nakao M, Rajadurai VS, Chandran S. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth. BMJ Case Rep 2017; 2017:bcr-2016-218818. [PMID: 28408368 DOI: 10.1136/bcr-2016-218818] [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: 11/03/2022] Open
Abstract
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
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Affiliation(s)
- Arpan Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore .,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
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14
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Abstract
Tracheal agenesis is an extremely rare congenital anomaly involving the respiratory system. It is generally associated with anomalies of other systems. Antenatal diagnosis of this condition is difficult; therefore, it presents as a medical emergency in the labor room. Intubation in these babies is difficult. As many of these babies are born prematurely, respiratory distress syndrome (RDS) adds to the management difficulties. Here, we describe two babies with this lethal anomaly and RDS where esophageal intubation and surfactant therapy proved beneficial. Furthermore, described are other associated anomalies.
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Affiliation(s)
- A V Desai
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - Sudha Rao
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - P R Shanbhag
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
| | - M Rupani
- Department of Neonatology, Nowrosjee Wadia Maternity Hospital, Mumbai, Maharashtra, India
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