Thoracoscopy for Esophageal Diverticula After Esophageal Atresia With Tracheo-Esophageal Fistula

Congenital and Iatrogenic Esophageal Diverticula in Infants and Children: A Case Series of Four Patients

In pediatric patients, esophageal diverticulum (ED) is rare and can be severe, especially when involving the cervical esophagus. Diagnosis and treatment typically start after birth, with some cases managed conservatively. This series presents four ED cases from Jose Marti y Perez Pediatric Teaching Hospital in Cuba (2003-2020). Symptoms included difficulty swallowing, regurgitation, and breathing problems. Three cases required surgery: a five-month-old post-esophageal-coloplasty (managed conservatively), a four-year-old post-esophageal atresia repair (diverticulum partially used to fix a narrow spot), and a 16-year-old with Zenker's diverticulum (requiring surgical removal). A 35-day-old baby with ED post-type C esophageal atresia surgery died from a pre-existing condition. Surviving patients lived healthy lives. ED in pediatrics can be congenital or iatrogenic post-esophageal repair. Reflux symptoms, respiratory distress, or a cervical mass should prompt suspicion of ED.

Diagnose and treatment for Type D congenital esophageal atresia with tracheoesophageal fistula

Importance

Type D esophageal atresia (EA) with tracheoesophageal fistula (TEF) is characterized by EA with both proximal and distal TEFs. It is a rare congenital anomaly with a very low incidence.

Objective

To investigate diagnostic and treatment strategies for this rare condition.

Methods

We retrospectively reviewed the clinicopathological features of patients with EA/TEF treated at our institution between January 2007 and September 2021.

Results

Among 386 patients with EA/TEF, 14 (3.6%) had type D EA/TEF. Only two patients were diagnosed with proximal TEF preoperatively. Seven patients were diagnosed intraoperatively. Five patients were missed for diagnosis during the initial surgery but was later confirmed by bronchoscopy. During the neonatal period, seven patients underwent a one-stage repair of proximal and distal TEF via thoracoscopy or thoracotomy. Due to missed diagnosis and other reasons, the other 7 patients underwent two-stage surgery for repair of the proximal TEF, including cervical incision and thoracoscopy. Ten of the 14 patients experienced postoperative complications including anastomotic leakage, pneumothorax, esophageal stricture, and recurrence. Patients who underwent one-stage repair of distal and proximal TEF during the neonatal period showed a higher incidence of anastomotic leak (4/7). In contrast, only one of seven patients with two-stage repair of the proximal TEF developed an anastomotic leak.

Interpretation

Type D EA/TEF is a rare condition, and proximal TEFs are easily missed. Bronchoscopy may aim to diagnose and determine the correct surgical approach. A cervical approach may be more suitable for repairing the proximal TEF.