Tracheoesophageal fistula with complex injury to the existing anomaly - Youngest neonate to survive: A case report
DOI:
https://doi.org/10.47338/jns.v10.940Keywords:
Esophageal atresia, Tracheoesophageal fistula, Neonate, Preterm, Tracheoesophageal traumaAbstract
Background: Complex injury to the esophagus, trachea, and tracheoesophageal fistula in a case of esophageal atresia is rarely reported that requires prompt identification and management.
Case Presentation: A very-low-birth-weight preterm with a tracheoesophageal fistula on ventilatory support for respiratory distress syndrome was transferred to our hospital. The baby developed air-leak through the tracheoesophageal fistula into the stomach causing gross distension of the stomach and reduction in oxygen saturation. Repositioning and reintubation failed to reduce the abdominal distension and to improve the saturation. Subsequent intubation with large volume, low pressure cuffed tube, and replacement of Replogle tube resulted in pneumothorax and further deterioration requiring emergency thoracotomy. Complex tracheoesophageal injury to the esophagus, trachea, and fistulous tract was repaired.
Conclusion: The baby survived the early repair of the tracheoesophageal fistula and the iatrogenic complex tracheoesophageal injury. Pre-operative tracheo-esophagoscopy with stenting of the fistula with Fogarty catheter helped to carry out a successful repair technically.
Downloads
Metrics
References
Hollwarth ME, Till H. Oesophageal atresia. In: Puri P, editor. Pediatric Surgery General principles and Newborn Surgery, 1st ed, Berlin: Springer-Verlag; 2020. p. 661-680.
Chahine AA, Ricketts RR. Esophageal atresia in infants with very low birth weight. Semin Pediatr Surg. 2000; 9:73-8.
Chee YY, Wong MS, Wong RM, Wong KY. Neonatal outcomes of preterm or very-low-birth-weight infants over a decade from Queen Mary Hospital, Hong Kong: comparison with the Vermont Oxford Network. Hong Kong Med J. 2017; 23:381-6.
Namasivayam S. Comprehensive preoperative airway assessment in tracheo-oesophageal fistula (TEF) In: Gupta P (Ed). Abstract book of 43rd Annual Conference of Indian Association of Paediatric Surgery: 21-24 September 2017.
Namasivayam S. Foley catheter stent for TEF repair - A preliminary study In: Pavai A (Ed). Abstract book of Annual Conference of Tamilnadu & Pondicherry State chapter of IAPS: July 2012.
Seitz G, Warmann SW, Schaefer J, Poets CF, Fuchs J. Primary repair of esophageal atresia in extremely low birth weight infants: a single-center experience and review of the literature. Biol Neonate. 2006; 90:247-51.
Gien J, Ing RJ, Twite MD, Campbell D, Mitchell M, Kinsella JP. Successful surgical management of airway perforation in preterm infants. J Pediatr Surg Case Rep. 2014; 2:47-51.
Templeton JM Jr, Templeton JJ, Schnaufer L, Bishop HC, Ziegler MM, O'Neill JA Jr. Management of esophageal atresia and tracheoesophageal fistula in the neonate with severe respiratory distress syndrome. J Pediatr Surg. 1985; 20:394-7.
McLeod BJ, Sumner E. Neonatal tracheal perforation. A complication of tracheal intubation. Anaesthesia. 1986; 41:67-70.
Rathod KK, Bawa M, Mahajan JK, Samujh R, Rao KL. Management of esophageal atresia with a tracheoesophageal fistula complicated by gastric perforation. Surg Today. 2011; 41:1391-4.
Wright VM, Noblett HR. A complication of continuous upper pouch suction in esophageal atresia. J Pediatr Surg. 1978; 13:369-70.
Acker SN, Bansal S, Somme S. A 25 weeks gestational age, 755 g neonate with esophageal atresia and tracheoesophageal fistula presents with ileal perforation and esophageal pouch perforation. Journal of Pediatric Surgery Case Reports. 2013; 1:395-7. Available from: https://doi.org/10.1016/j.epsc.2013.10.009.
Parelkar S, Mundada D, Joshi P, Sanghvi B, Kapadnis S, Oak S. Iatrogenic perforation of upper pouch in pure esophageal atresia: a rare complication and review of literature. European J Pediatr Surg Rep. 2013; 1:21-3.
Dwivedi D, Makkar J, Sharma R, Jafra A. Pneumomediastinum following iatrogenic pharyngeal perforation during tracheoesophageal fistula repair. Saudi J Anaesth. 2018; 12:355-7.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Namasivayam Selvarajan, Chandra Kumar Natarajan , Singaravelu Ramesh, Vanathi Vijayakumar, Saravana Balaji Muthukrishnan , Naga Srinivasa Uday Bhaskar Mokrala , Anis Akhtarkhavari
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.