Cases reported "Esophageal Atresia"

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11/62. [Operated esophageal atresia of late diagnosis, with postoperative survival]

    The authors present two cases of oesophageal atresia with oeso-tracheal communication that, although they have been diagnosed in the 2-nd and the 4-th day of life, have been operated successfully. Both children, investigated at the age of one and one and a half years respectively, are in perfect health.
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12/62. A rare case of esophageal atresia with gastric outlet obstruction.

    Although the combination of gastric outlet obstruction and esophageal atresia is rarely seen in neonates, it has been well described. We report the case of a 5-day-old newborn with esophageal atresia and tracheoesophageal fistula associated with complete gastric outlet obstruction due to a mucous plug. As the patient had intense gastric distention, severe respiratory distress requiring ventilatory therapy and complete pyloric obstruction in radiograms, emergency gastrostomy was performed before definitive operation. Definitive treatment consisted of tracheoesophageal fistula ligation and primary esophageal anastomosis. Exploratory laparotomy during the same session revealed a normal pyloric canal, completely obstructed by a firm mucous plug. The plug was removed by pylorotomy, and a pyloroplasty was performed to ease gastric evacuation. Postoperative feeding problems suggested gastric dysmotility as the possible cause for the mucous plug obstruction.
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13/62. Laparoscopically assisted gastric pull-up for long gap esophageal atresia.

    BACKGROUND: Laparoscopically assisted gastric pull-up procedure has been performed in adults for various conditions. The authors report the first patient, who underwent laparoscopically assisted esophageal replacement for long gap esophageal atresia. methods: The patient had Down's syndrome and long gap esophageal atresia without fistula. A gastrostomy was performed right after birth, and a suction drain was positioned in the upper esophageal pouch. Esophageal replacement took place at the age of 3 months. The laparoscopic operation included complete mobilization of the stomach, resection of the lower esophageal stump (Endo-GIA), pyloroplasty, and transhiatal dissection. After a right cervical approach, the gastric pull-up was performed through the posterior mediastinum, and the upper anastomosis was completed. Finally, a laparoscopic jejunostomy was performed. RESULTS: The duration of the operation was 4.5 hours. The intra- and postoperative courses were uneventful. Feeding via the jejunostomy was started on day 1. gastric emptying of contrast media was documented by x-ray examination. Oral feeding was started on day 8 and is now, 3 months postoperative, well tolerated. CONCLUSIONS: This is the first report on laparoscopically assisted gastric pull-up for long gap esophageal atresia. The technique represents an option for the treatment of long gap esophageal atresia.
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14/62. Successful management of severe chylothorax with argon plasma fulguration and fibrin glue in a premature infant.

    Post-traumatic neonatal chylothorax is a rare entity. Management includes medical and surgical treatment. We describe here a newborn who developed a severe chylothorax after repair of an oesophageal atresia. The chylothorax was treated successfully by a combination of argon beam coagulation of the mediastinum and fibrin glue application. However, the patient developed complete thrombosis of the left femoral vein with clot extension to the inferior vena cava which resolved after infusion of recombinant tissue plasminogen activator (rt-PA). The use of argon plasma coagulation and mediastinal fibrin glue application for treating postoperative chylothorax appears to be attractive and is easy to perform even in small premature infants and may replace a more extensive surgical procedure. However, the coagulation profile should be monitored and special care should be taken to prevent vascular thrombosis after surgery.
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15/62. Delayed primary reconstruction of an esophageal atresia with distal esophagotracheal fistula in an infant weighing less than 500 g.

    Delayed primary reconstruction of an esophageal atresia (Vogt IIIb) was undertaken in an extremely small-for-date baby (second twin, 36th week) with a birth weight of 445 g. After initial insertion of a gastrostomy under local anesthesia on the 29th day of life, ligation of the fistula and end-to-end anastomosis were performed by transpleural access (weight then, 535 g). There were no complications related to the operative procedure. The baby weighed 1,600 g at the age of 8 months.
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ranking = 0.25
keywords = operative
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16/62. The elongation of distal esophageal pouch by mechanical bougienage for a year resulted in a tension-free anastomosis in a patient with long gap esophageal atresia: a case report.

    Despite the numerous approaches described for the management of neonates with "long gap" esophageal atresia, controversy still exists as to the preferred method. Delayed primary anastomosis is probably the most frequently adopted practice but often the native esophagus is abandoned. We report a case of a 2.98 kg newborn with pure esophageal atresia. Although the elongation of the distal esophageal pouch by mechanical bougienage was initiated at 1 year and 8 months, a successful tension-free anastomosis with minimum dissection of the lower esophagus was performed at 2 years and 7 months. Her postoperative quality of life has been quite excellent. This report emphasizes that a tension-free anastomosis without operating on the lower esophagus and stomach is essential for the treatment of long-gap esophageal atresia.
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keywords = operative
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17/62. somatostatin for intractable postoperative chylothorax in a premature infant.

    A premature infant of 31 weeks' gestation underwent repair of an oesophageal atresia, distal tracheo-oesophageal fistula and anal stenosis. A lymphatic leak was noted at the time of surgery. Chylous drainage persisted and an intravenous infusion of somatostatin was begun. The volume of chyle drained fell dramatically within the first 24 h and was negligible by the 5th day of treatment. No reaccumulation of the chylothorax was seen after the cessation of somatostatin. To our knowledge this is the youngest reported child in whom somatostatin has been used successfully in treating a postoperative chylothorax.
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ranking = 1.25
keywords = operative
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18/62. Ileal pedicle grafting for esophageal replacement in children.

    Reconstruction of the upper esophagus in small children remains a challenge. Free jejunal interposition as frequently used in adults is much less appropriate in children because of the limited vessel size. The use of a jejunal pedicle graft in children has been described, but gaining enough length may be a problem. A pedicle graft of terminal ileum may be a better option, but this technique has never been described. We report a child with esophageal atresia and distal fistula who had a very short upper esophageal pouch. Primary repair was impossible. The fistula was ligated and a gastrostomy created. A second attempt at anastomosis was not successful either, and a cervical esophagostomy was created. The child was fed by gastrostomy and received sham feeding orally. When the child was 10 months old, the upper esophagus was successfully reconstructed with a pedicle graft of terminal ileum. Postoperatively there was a limited leak of the proximal anastomosis, which healed spontaneously. The distal anastomosis had to be dilated on a few occasions. With a follow-up of 1 year, the child is eating well without gastrostomy supplementation. On imaging, the ileal pedicle graft looks somewhat tortuous but contracts nicely. We feel that ileal pedicle graft reconstruction of the esophagus should be part of the instrumentarium of pediatric surgeons dealing with esophageal reconstruction.
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ranking = 0.25
keywords = operative
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19/62. Reimplantation of oesophageal bronchus following a type III oesophageal atresia repair.

    Oesophageal atresia can be associated with communicating bronchopulmonary foregut malformations, the most common being the oesophageal bronchus. lung resection may be mandatory, but conservative treatment correcting the abnormal airway has been proposed, raising the difficult issue of perioperative ventilatory support. The authors report a case of successful reimplantation of oesophageal bronchus revealed after surgical cure of an oesophageal atresia with tracheo-oesophageal fistula.
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ranking = 0.25
keywords = operative
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20/62. Major anastomotic dehiscence after repair of esophageal atresia: conservative management or reoperation?

    SUMMARY. The authors report a case of recurrent anastomotic dehiscence following surgical repair of type C esophageal atresia according to the Gross classification. Surgical repair was followed by a recurrence, which was successfully managed with conservative treatment. esophageal atresia with fistulization of the lower pouch in a male newborn with the VACTER association was repaired with a high-tension single-layer anastomosis. On the fifth postoperative day, major anastomotic dehiscence (> 4 mm) was diagnosed. The breach was re-sutured and the anastomosis reinforced with fibrin glue, but dehiscence recurred again 4 days later. Surgery was deferred and the infant was treated conservatively with continued chest-tube drainage and total parenteral nutrition. After 43 days, complete closure of the anastomosis was documented. Even major anastomotic dehiscence can be successfully managed with conservative treatment (chest-tube drainage, suspension of oral feedings, total parenteral nutrition). If the patient is otherwise stable, we feel that this approach should be attempted even when major leakage is present.
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keywords = operative
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