Endoscopic laser division of an esophageal web in a child

The authors report the first successful endoscopic laser division of a congenital esophageal web in a child in whom dilatation had failed. Laser lysis is minimally invasive and should be attempted before surgery is considered.

Isolated congenital esophageal stenosis

The incidence of congenital esophageal stenosis (CES) is approximately 1 in 25,000 to 50,000 live births. There is associated esophageal atresia in one third of cases; the remainder are classified as isolated CES. Histologically, the anomaly may include tracheobronchial remnants, a membranous diaphragm, or diffuse fibrosis of the muscularis and submucosa. The authors report their experience with three patients who had isolated CES. The patients were free of symptoms for the first 6 months of life. All had difficulty with feeding from 6 to 12 months of age, which corresponded with the introduction of solids. Most solid feedings were regurgitated. Evaluation consisted of cine-esophagogram, pH monitoring, manometry, and endoscopy, with biopsies to exclude the diagnosis of gastroesophageal reflux. All patients underwent hydrostatic dilatation, but the benefit was only transient. The patients were referred for surgical correction when symptoms recurred. Limited resection of the esophageal stenosis with primary anastomosis was performed on all three patients via a left thoracotomy. The stenoses were located in the distal third of esophagus, near the junction with the middle third. Pathological examination showed tracheobronchial remnants in one patient and fibrotic muscle in the other two. The average age at the time of surgery was 19 months. The hospital stay averaged 8 days. The contrast study 1 week postthoracotomy showed esophageal patency in all patients, with no leakage. All were discharged from the hospital, tolerating solid food. CES should be sought for in patients who present with dysphagia to solid food that begins after the first 6 months of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Peptidergic and nitrinergic denervation in congenital esophageal stenosis

Congenital esophageal stenosis (CES) is a rare disorder with narrowed esophageal lumen that presents as dysphagia from childhood and that is often associated with tracheobronchial remnants or webs. The pathogenesis of CES is unknown. The aim of this study was to examine the histological and immunohistochemical features of CES. Esophagi from 2 young adults with CES and 3 controls with no motility disorders underwent routine H&E staining, trichrome staining for collagen, and detailed immunocytochemical studies for general neuronal markers (protein gene product 9.5, neuron-specific enolase, and S-100) and neurotransmitters (vasoactive intestinal polypeptide, substance P, and galanin) and nitric oxide synthase by beta-nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase and a specific NO synthase antibody. Quantitative experiments compared the numbers of myenteric neurons and amounts of fibers at the circular muscle. CES esophagi showed infiltration of neutrophils in the myenteric plane, without any increase in collagen. NADPH-diaphorase histochemistry showed a significant reduction of myenteric nitrinergic neurons (7 +/- 3.4 vs. 2.7 +/- 1.8 neurons per high-power field) and fibers at the circular muscle. Other peptidergic neurons studied were not significantly reduced in CES. The specific total lack of NO inhibitory innervation may be an important mechanism in the pathogenesis of stenosis and aperistalsis of the esophagus in this disorder.

[Dysphagia in children. Imaging]

While oesophageal obstacles are responsible for regurgitation or aspiration in neonates and infants, older children present with dysphagia. Before any investigation, a buccopharyngeal infection must first be eliminated clinically. In the absence of fever, the ingestion of a foreign body or caustic substances must be considered, either in an acute context, or in a chronic context related to cicatricial stenosis. Tumour or congenital lesions are less common, whether intrinsic (stenosis, fistulas, duplications), or extrinsic (vascular malformations, mediastinal tumours). Radiological investigation is based on simple techniques: chest X-ray and barium swallow are usually sufficient to establish the aetiological diagnosis.

Congenital esophageal stenosis presenting as noncardiac, esophageal chest pain

A case of a 31-year-old female with congenital esophageal stenosis presenting with symptoms of chest pain caused by esophageal dysmotility is described. The involved segment in congenital esophageal stenosis has a characteristic thickening of the muscularis propria layer, as seen by EUS examination. In these patients, symptoms of dysphagia can be managed with esophageal dilation and noncardiac esophageal chest pain responds to pharmacotherapy with diltiazem.

H-type tracheoesophageal fistula and congenital esophageal stenosis

An 18-month-old boy was seen in the pediatric pulmonary clinic with a history of wheezing, stridor and intolerance to solid foods. Barium esophagram revealed distal esophageal stenosis and subsequently an H-type TEF at surgery. Following the surgery to repair both lesions the child continues to do well.

[Congenital esophageal stenosis with submucosal fibrosis: report of one case]

Esophageal stenosis due to an intrinsic congenital factor is uncommon in infancy. We report a case of a male newborn infant, who was well at birth and presented with foamy sputum from the third day of life and vomiting at 18 days of age. Esophagogram revealed a narrowed segment, about 1 cm in length, at the level of the seventh and eighth cervical vertebral bodies, with proximal dilatation. There was no sign of gastroesophageal reflux. Operative findings: There was no external compression, foreign body or fistula, but a 1 cm length of esophageal stenosis was found. The stenosed segment was hard on palpation. Segmental resection of the stenosed region, with direct anastomosis of the esophagus was performed. Pathological examination of the narrowed segment revealed fibrosis of the submucosa without any tracheobronchial remnent components.

Familial multiple congenital esophageal rings: report of an affected father and son

Multiple esophageal rings are a very unusual cause of dysphagia. We report a case of a 35-yr-old male with multiple esophageal rings and severe dysphagia, whose father had similar symptoms. Our patient underwent esophageal dilation on one occasion and is asymptomatic at 1-yr followup. We speculate that multiple esophageal rings may be of congenital origin.

Congenital esophageal stenosis due to tracheobronchial remnants: a rare but important association with esophageal atresia

Congenital esophageal stenosis caused by tracheobronchial remnants occurred in eight children, six of whom had associated esophageal atresia and/or tracheoesophageal fistula. Symptoms usually began in early infancy but delayed diagnosis was a common feature. The mean lag period between presentation and definitive operation was 4.6 years (range, 1 month to 16 years). Errors in diagnosis were common. Six were initially diagnosed as having inflammatory strictures secondary to reflux esophagitis. Seven children were subjected to repeated esophagoscopy and bouginage of the "stricture" (mean no. = 3.4), with invariable failure to ameliorate dysphagia. Antireflux procedures were performed in three patients. In all children, symptoms were dramatically relieved following resection of the stenotic segment or esophageal replacement. Although a rare entity, congenital esophageal stenosis due to tracheobronchial remnants should be considered a possibility in patients with esophageal stricture, presumed to be inflammatory in nature, which fails to respond to standard therapy.

Probable congenital esophageal stenosis in a thoroughbred foal

Esophageal stenosis was diagnosed in a 7-day-old Thoroughbred foal referred for evaluation of bilateral milky nasal discharge. Double-contrast radiography revealed concentric narrowing of the esophagus at the level of the fifth rib, overlying the base of the heart. Lateral displacement of the esophagus was not apparent. X-ray computed tomography of the cranial portion of the thorax confirmed normal cardiac and great vessel anatomy, ruling out vascular ring anomaly. A nasogastric tube was placed, extending past the stenosis and into the stomach, and the foal was fed mares' milk via this tube. On day 14, the foal was allowed to nurse the mare hourly and was made to stand, with the cranial half of its body elevated for 5 minutes after each feeding. On day 19, the foal was allowed to nurse ad libitum and eat hay and grain with the mare. Signs of regurgitation and aspiration were not apparent. On day 29, the foal was discharged to the owner.

[Congenital esophageal stenosis associated with corneosclera]

One case of congenital esophageal stenosis due to tracheobronchial remnants and associated with microphthalmos and corneosclera is reported. Diagnostic and therapeutic methods employed are discussed.

Congenital esophagostenosis

By means of two of our own cases we report on congenital esophagostenosis which occurs in a proportion of 1:50,000. The typical clinical symptoms consist of frequent vomiting, regurgitation of undigested food particles which have no acid smell, and regurgitation of viscous mucus and saliva. In the last decade direct operative treatment has taken the place of primary bougienage therapy.

Distal congenital esophageal stenosis associated with esophageal atresia

A series of six patients with congenital esophageal stenosis associated with esophageal atresia (EA) and distal tracheoesophageal fistula is presented. Three patients required only repeated dilatations, and have had good results. Two patients required limited resections of the distal esophagus, with excellent results. One patient died following a Heller myotomy. Tracheobronchial rests were present in the distal esophagus in the latter three patients. Diagnosis of congenital distal esophageal stenosis following repair of EA requires a high index of suspicion and a careful review of previous esophagrams. It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy, and esophageal pH monitoring. Once a congenital basis for distal esophageal stenosis is suspected, management consists of dilatation by bouginage followed by balloon dilatation. Resection is reserved for persistent stenoses from tracheobronchial rests, which usually do not respond to dilatations.

Oesophageal stenosis distal to oesophageal atresia

Oesophageal atresia with or without tracheo-oesophageal fistula is often associated with a functionally abnormal distal oesophagus. The association of oesophageal atresia and a distal oesophageal stenosis is less well recognized and is usually regarded as a rarity. We describe four cases of oesophageal stenosis distal to oesophageal atresia and review the literature relating to this condition.

Congenital esophageal stenosis. A rare cause of food impaction in the adult

When esophageal peristalsis is preserved, the presentation of congenital esophageal stenosis may be delayed until adulthood. Serial Maloney dilations are a safe and effective method of treating muscular congenital esophageal stenosis.

[Treatment of esophageal stenosis in children]

Esophageal stenoses, both congenital and acquired, represent a serious problem in childhood due to the deleterious effects, of these anomalies in the patients nutritional state and lifestyle. Choosing the best way to the solution of such problems is of primary importance, paying special attention to the techniques that may not compromise irreversibly the continuity of the alimentary tract. The authors experience on the treatment of 77 esophageal stenoses, 8 of which were congenital and 69 acquire, is reported. Of this group, 24 are sequelae of esophageal atresias, 33 are of caustic origin and 12 of peptic nature. In 3 congenital stenoses with a cartilaginous matrix, surgical repair was undertaken. In the remaining cases forward and retrograde dilatation guided by a thread, through the gastrostomy orifice were performed, in accordance to the length and severity of the stenoses. Duration of the treatment varied broadly, ranging from 3-5 anterograde sessions, in the cases of esophageal atresia sequelae, to several years with an average monthly periodicity of one session in cases of total pharyngoesophageal caustic burn. As for complications, there were three cases of mediastinitis and two of subcutaneous infiltrations at the cervical level that were solved with antibiotics. The authors believe, on the basis of their experience, the absence of mortality and the scarce morbidity that, in the pediatric patients the treatment of choice of esophageal stenoses consists of dilatations on their different modalities. A yearly follow-up must be strictly maintained until the patients have completed their growth. We reject esophageal coloplasties in the pediatric age because of their complications rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous perforation of cervical oesophagus associated with oesophageal web

A case is described, of a patient who sustained a spontaneous perforation of the cervical oesophagus in association with a congenital oesophageal web.

Congenital stenosis of the lower esophagus associated with leiomyoma and leiomyosarcoma of the gastrointestinal tract

The purpose of this paper is to report our analysis of four generations of a family with congenital strictures of the lower esophagus associated with leiomyoma of the gastrointestinal tract. Two members of the family died of sarcomatous degeneration of the leiomyoma and one is still alive 2 years after resection of the malignancy. Three family members had surgical repair of the congenital stricture. Surgical repair was unnecessary in one, for whom repeated dilatations alleviated the symptoms. Since there were no direct female descendants in this family, it is unknown whether this hereditary disease is carried by a sex-linked dominant gene. There are no reports in the literature of a familial tendency to congenital strictures of the esophagus, nor are there any reports of strictures in association with gastrointestinal leiomyoma and the later development of sarcomatous degeneration. The literature is reviewed, syndromes of leiomyoma of the esophagus and gastrointestinal tract are detailed, the particulars of the family tree and the patients are described, and the study is summarized.

Congenital esophageal stenosis due to tracheobronchial cartilage

Six cases of lower esophageal stenosis due to tracheo-bronchial remnants are reported. The symptoms become apparent after weaning. Esophagography and esophagoscopy are the essential means for diagnosis. The treatment includes resections of the stenotic segment and an end-to-end anastomosis.