A Case of Gross type D Esophageal Atresia Diagnosed Preoperatively: Consideration of Preoperative Diagnosis

  • Hasebe Tatsuya
    Department of Pediatric Surgery, Hirosaki University Graduate School of Medicine Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine
  • Sugai Michihiro
    Department of Pediatric Surgery, Hirosaki University Graduate School of Medicine
  • Kobayashi Tamotsu
    Department of Pediatric Surgery, Hirosaki University Graduate School of Medicine
  • Hakamada Kenichi
    Department of Pediatric Surgery, Hirosaki University Graduate School of Medicine Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine

Bibliographic Information

Other Title
  • 術前診断されたD 型食道閉鎖症の1例
  • 症例報告 術前診断されたD型食道閉鎖症の1例 : 術前診断に関しての考察
  • ショウレイ ホウコク ジュツゼン シンダン サレタ Dガタ ショクドウ ヘイサショウ ノ 1レイ : ジュツゼン シンダン ニ カンシテ ノ コウサツ
  • ―術前診断に関しての考察―

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Abstract

In the present report, we describe a case of Gross type D esophageal atresia (EA) that was diagnosed preoperatively. The patient was a male infant delivered at 41 weeks and 5 days, with a birth weight of 3,836 g. He was suspected of having EA on the basis of findings of drooling, cyanosis, and meconium staining. In addition, the medical staff encountered difficulty in inserting a nasogastric tube. However, chest radiography did not indicate coiling of the nasogastric tube, and thus esophagography was performed. Esophagography indicated the upper esophageal pouch, trachea, and lower esophagus. On the basis of these findings, he was diagnosed as having Gross type D EA. He was then transferred to our hospital and underwent primary anastomosis and fistula ligation on the same day. After the operation, a proximal tracheo-esophageal fistula (TEF) scar resulted in the development of tracheomalacia and tracheal collapse. Therefore, we performed tracheostomy 28 days after the surgery for fistula ligation. The infant’s respiratory condition became stable after the tracheostomy. He was weaned from mechanical ventilation and transferred to the pediatrics unit 30 and 42 days after the fistula ligation, respectively. Although the preoperative diagnosis of Gross type D EA is difficult, severe respiratory complications may develop if proximal TEF is overlooked. Hence, proximal TEF should be considered in all cases of EA. We consider that preoperative bronchoscopy is the most appropriate method for diagnosing proximal TEF.

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