Neonatal Med.  2018 Nov;25(4):186-190. 10.5385/nm.2018.25.4.186.

Esophageal Reconstruction with Gastric Pull-up in a Premature Infant with Type B Esophageal Atresia

• Han YM
• Lee N
• Byun SY
• Kim SH
• Cho YH
• Kim HY

• KMID: 2436137
• DOI: http://doi.org/10.5385/nm.2018.25.4.186

Abstract

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.

Keyword

Esophageal atresia; Tracheoesophageal fistula; Premature infant

MeSH Terms

Body Weight
Bronchoscopy
Diagnosis
Diet
Enteral Nutrition
Esophageal Atresia*
Esophagostomy
Fetal Growth Retardation
Fistula
Gastrostomy
Humans
Infant
Infant, Newborn
Infant, Premature*
Male
Parturition
Pneumonia
Pregnancy
Stomach
Tracheoesophageal Fistula

Figure

• 

  Figure 1. (A) Day 1 after birth: infantography of the patient with suspected gross type A esophageal atresia demonstrating the curling of a radiopaque Levin tube in the upper pouch (arrow) and the absence of luminal gas below the diaphragm. The absence of stomach gas was continuous on serial infantography. (B) Day 48 after birth: increased haziness in the right lung due to recurrent pneumonia. The arrow indicates a feeding tube inserted via gastrostomy. (C) Day 65 after birth: improved lung condition after tracheoesophageal fistula excision and cervical end esophagostomy (arrow). A Levin tube was inserted into the jejunum for continuous feeding (arrowheads).

• 

  Figure 2. (A) Esophagogram taken 7 days after esophageal reconstruction with gastric pull-up, showing no leakage or stricture. (B) Chest radiograph taken 30 days after esophageal reconstruction with gastric pull-up.

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