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Pham A, Ezzeddine L, Bonnard A, Lapillonne A, Rousseau V, Montalva L, Khattat N, Guilbert J, Mokhtari M, Fouquet V, Jaby O, Decobert F, Mitanchez D, Ducou Le Pointe H, Irtan S. Usefulness of routine early œsophagogram after primary repair of œsophageal atresia: a multicenter study. Pediatr Res 2023; 94:1779-1783. [PMID: 37328687 DOI: 10.1038/s41390-023-02696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Advances in surgical and neonatal care have led to improved survival of patients with œsophageal atresia (OA) over time. Morbidity remains significant, with one-third of patients being affected by a postoperative complication. Several aspects of management are not consensual, such as the use of œsophagogram before starting oral feeding. METHODS We conducted a multicenter retrospective study, including all children with OA that underwent a primary anastomosis in the first days of life, between 2012 and 2018 in five French centers, to determine the usefulness of postoperative œsophagogram during the 10 days after early primary repair of OA to diagnose the anastomotic leak and congenital œsophageal stenosis. RESULTS Among 225 included children, 90 (40%) had a routine œsophagogram and 25 (11%) had an anastomotic leak, clinically diagnosed before the scheduled œsophagogram in 24/25 (96%) children at median postoperative day 4. Ten patients had associated congenital œsophageal stenosis diagnosed on the œsophagogram in only 30% of cases. CONCLUSION Early œsophagogram is rarely useful in the diagnosis of an anastomotic leak, which is clinically diagnosed before performing an œsophagogram in the majority of cases. The need for a postoperative œsophagogram should be evaluated on a case-by-case basis. IMPACT Early œsophagogram is not helpful in the diagnosis of an anastomotic leak in the majority of cases. An anastomotic leak is most often diagnosed clinically before performing an œsophagogram. Early postoperative œsophagogram could be helpful for the diagnosis of congenital œsophageal stenosis. However, dysphagia occurs later and early diagnosis of congenital œsophageal stenosis has no impact on the management and outcome of asymptomatic children. Indication of postoperative œsophagogram has to be evaluated on a case-by-case basis.
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Affiliation(s)
- Aurélie Pham
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Neonatal Medicine, 75012, Paris, France.
| | - Lynn Ezzeddine
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Arnaud Bonnard
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Alexandre Lapillonne
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Neonatal Intensive Care Unit, 75015, Paris, France
| | - Véronique Rousseau
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Department of Pediatric Surgery, 75015, Paris, France
| | - Louise Montalva
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Nizar Khattat
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Neonatal Intensive care unit, 75019, Paris, France
| | - Julia Guilbert
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Intensive neonatal and pediatric care unit, 75012, Paris, France
| | - Mostafa Mokhtari
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Neonatal Intensive care unit, 94250, Le Kremlin Bicêtre, France
| | - Virginie Fouquet
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Department of Pediatric Surgery, 94250, Le Kremlin Bicêtre, France
| | - Olivier Jaby
- Centre hospitalier intercommunal de Créteil, Department of Pediatric Surgery, 94300, Créteil, France
| | - Fabrice Decobert
- Centre hospitalier intercommunal de Créteil, Neonatal Intensive Care Unit, 94300, Créteil, France
| | - Delphine Mitanchez
- François Rabelais University, CHRU de Tours, Bretonneau Hospital, Neonatal Intensive Care Unit, 37000, Tours, France
| | - Hubert Ducou Le Pointe
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Sabine Irtan
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of visceral and neonatal pediatric surgery, 75012, Paris, France
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Parekh S, Ochotny R, Lazow SP, Ben-Ishay O, Aribindi V, Pluchinotta FR, Tworetzky W, Buchmiller TL, Peyvandi S, Moon-Grady AJ. High prevalence of left superior vena cava and congenital heart disease in patients with pre- and postnatally diagnosed esophageal atresia/tracheoesophageal fistula. Ultrasound Obstet Gynecol 2023; 62:439-440. [PMID: 36929674 DOI: 10.1002/uog.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- S Parekh
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - R Ochotny
- Department of Palliative Care, Akron Children's Hospital, Akron, OH, USA
| | - S P Lazow
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - O Ben-Ishay
- Department of General Surgery, Ramban Healthcare Campus, Haifa, Israel
| | - V Aribindi
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - W Tworetzky
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - T L Buchmiller
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - S Peyvandi
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
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Ge Y, Xu B, Shi J, Tang W. Application value of high-frequency ultrasound combined with ultrasonography in the diagnosis of neonatal esophageal atresia. Afr Health Sci 2023; 23:547-553. [PMID: 38357118 PMCID: PMC10862570 DOI: 10.4314/ahs.v23i3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Objective To explore the application value of high-frequency ultrasound combined with ultrasonography in the diagnosis of neonatal esophageal atresia (EA). Methods Seventy neonates with suspected EA who received healing in our hospital from August 2019 to April 2022 were retrospectively selected as the study subjects and their preoperative esophageal high-frequency ultrasound and ultrasound hydrography data were analysed. The diagnostic value of high-frequency ultrasound, ultrasound hydrography and combined detection in neonatal EA was analysed using intraoperative findings as the gold standard. Results (1) Among the 70 children with suspected EA, 62 were confirmed to be positive and 8 were negative; 59 were positive and 11 were negative by ultrasound hydrography alone; 61 were positive and 9 were negative by high-frequency ultrasound alone; 62 were positive and 8 were negative by combined detection.(2) The accuracy of combined detection was 97.14%, which was notably different from 92.86% by high-frequency ultrasound and 84.29% by ultrasound hydrography (P < 0.05).(3) The diagnostic AUC of ultrasound hydrography, high-frequency ultrasound, and combined detection for EA was 0.6125, 0.6500, and 0.6563, respectively (P < 0.05).(4) There was no significant variation in the distance between preoperative high-frequency ultrasound, ultrasound hydrography, and intraoperative measurements of distal and proximal blind ends of type IIIA and IIIB EA esophagus (P > 0.05). Conclusion High frequency ultrasound and super fresh water injection angiography have good application value in the diagnosis of neonatal EA. There is no significant difference between the distance between the distal and proximal blind ends of the esophagus before and during the operation of type III EA and that during the operation of super fresh water injection angiography. However, in consideration of the risk of radiation and poisoning caused by esophagography, it is recommended that high-frequency ultrasound be selected first for diagnosis and if necessary, esophagography be supplemented for joint diagnosis.
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Affiliation(s)
- Yurong Ge
- Department of Ultrasonic Medicine, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou P.R. China ,550003
| | - Baoyue Xu
- Weihai Municipal Hospital Shandong, China
| | - Jing Shi
- Department of Ultrasonic Medicine, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou, P.R. China, 550003
| | - Weiwei Tang
- Department of Ultrasound Medicine, Affiliated Hospital of Xiangnan University, Chenzhou, China
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Takada S, Shirota C, Uchida H, Amano H, Hinoki A, Sumida W, Makita S, Okamoto M, Takimoto A, Yasui A, Nakagawa Y, Kato D, Guo Y, Tainaka T. Management of Congenital and Postoperative Chylothorax: Use of Thoracoscopic Lymphatic Leak Ligations with Intraoperative ICG Lymphangiography. J Pediatr Surg 2023; 58:1754-1761. [PMID: 36609065 DOI: 10.1016/j.jpedsurg.2022.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence lymphangiography. METHODS A retrospective review of patients with CCT and POCT from 2014 to 2021 was performed. After definitive diagnosis, conservative treatments with octreotide, followed by intravenous steroids as needed, were performed. Patients who were refractory to conservative treatment were transferred to surgical treatment, consisting of thoracoscopic lymphatic leak ligations using ICG intraoperative lymphangiography. The effectiveness of conservative and surgical treatment was then examined. RESULTS We included 19 cases of CCT and 31 cases of POCT. The 31 POCT patients included 23 of 84 postoperative patients with congenital diaphragmatic hernia (CDH), 7 of 54 postoperative patients with esophageal atresia (EA), and 1 of 3 postoperative patients with lymphatic malformation. The efficacy of conservative treatment was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%. CONCLUSION Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Youichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Gerrie SK, Navarro OM. Imaging Features of Neonatal Bowel Obstruction. Radiographics 2023; 43:e230035. [PMID: 37471246 DOI: 10.1148/rg.230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential diagnoses. The key to providing an appropriate differential diagnosis comes from a combination of the patient's gestational age, clinical features, and imaging findings. While assessment of radiographs can confirm bowel obstruction and indicate whether it is likely proximal or distal, additional findings at upper or lower gastrointestinal contrast study together with use of US are important in providing an appropriate differential diagnosis. The authors provide an in-depth assessment of the appearances of the most common differential diagnoses of proximal and distal neonatal bowel obstruction at abdominal radiography and upper and lower gastrointestinal contrast studies. These are divided into imaging patterns and their associated differential diagnoses on the basis of abdominal radiographic findings. These findings include esophageal atresia variants including the "single bubble," "double bubble," and "triple bubble" and distal bowel obstruction involving the small and large bowel. Entities discussed include esophageal atresia, hypertrophic pyloric stenosis, pyloric atresia, duodenal atresia, duodenal web, malrotation with midgut volvulus, jejunal atresia, ileal atresia, meconium ileus, segmental volvulus, internal hernia, colonic atresia, Hirschsprung disease, and functional immaturity of the large bowel. The authors include the advantages of abdominal US in this algorithm, particularly for hypertrophic pyloric stenosis, duodenal web, malrotation with midgut volvulus, and segmental volvulus. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Samantha K Gerrie
- From the Department of Radiology, BC Children's Hospital, 4500 Oak St, Vancouver, BC, Canada V6H 3N1, and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (S.K.G.); and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada, and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Department of Radiology, BC Children's Hospital, 4500 Oak St, Vancouver, BC, Canada V6H 3N1, and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (S.K.G.); and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada, and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (O.M.N.)
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Moreno-Alfonso JC, Peñarrieta-Daher A, Peña M, Zalles-Vidal C. Esophageal atresia and airway malformations: beyond tracheoesophageal fistula. Atresia de esófago y malformaciones de la vía aérea: más allá de la fístula traqueoesofágica. An Pediatr (Barc) 2023; 99:143-144. [PMID: 37474418 DOI: 10.1016/j.anpede.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/11/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Julio César Moreno-Alfonso
- Cirugía Pediátrica, Hospital Universitario de Navarra, Pamplona, Spain; Universidad Pública de Navarra, Pamplona, Spain.
| | | | - Mario Peña
- Cirugía de Tórax y Endoscopia Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Cristian Zalles-Vidal
- Cirugía Neonatal, Hospital Infantil de México Federico Gómez, Ciudad de México, México
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Prakash S, Kumar R, Tripathi M, Jha V, Bajpai M. Gastric Mucosal Viability Assessment Using 99mTcO4 in a Case of Pure Esophageal Atresia After Isoperistaltic Gastric Tube Replacement. Clin Nucl Med 2023; 48:e145-e146. [PMID: 36723902 DOI: 10.1097/rlu.0000000000004452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Gastric surface mucosal cells are responsible for the uptake and secretion of 99mTcO4, a feature that has been used in imaging heterotopic gastric mucosa. We used the same principle to look for gastric mucosal viability in this case of pure esophageal atresia admitted for cervical stomal closure after a previous isoperistaltic gastric tube (IGT) replacement procedure. 99mTcO4 scintigraphy was done after encountering a failure to maneuver the esophagoscope through the IGT. The study was helpful in assessing the loss of gastric mucosal viability in an intervening segment of the IGT.
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Affiliation(s)
| | | | | | - Vimalendu Jha
- Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Marks KT, Higano NS, Kotagal M, Woods JC, Kingma PS. Magnetic Resonance Imaging-Based Evaluation of Anatomy and Outcome Prediction in Infants with Esophageal Atresia. Neonatology 2023; 120:185-195. [PMID: 36812903 PMCID: PMC10118939 DOI: 10.1159/000526794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/24/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION There is currently no validated diagnostic modality to characterize the anatomy and predict outcomes of tracheal esophageal defects, such as esophageal atresia (EA) and tracheal esophageal fistulas (TEFs). We hypothesized that ultra-short echo-time MRI would provide enhanced anatomic information allowing for evaluation of specific EA/TEF anatomy and identification of risk factors that predict outcome in infants with EA/TEF. METHODS In this observational study, 11 infants had pre-repair ultra-short echo-time MRI of the chest completed. Esophageal size was measured at the widest point distal to the epiglottis and proximal to the carina. Angle of tracheal deviation was measured by identifying the initial point of deviation and the farthest lateral point proximal to the carina. RESULTS Infants without a proximal TEF had a larger proximal esophageal diameter (13.5 ± 5.1 mm vs. 6.8 ± 2.1 mm, p = 0.07) when compared to infants with a proximal TEF. The angle of tracheal deviation in infants without a proximal TEF was larger than infants with a proximal TEF (16.1 ± 6.1° vs. 8.2 ± 5.4°, p = 0.09) and controls (16.1 ± 6.1° vs. 8.0 ± 3.1°, p = 0.005). An increase in the angle of tracheal deviation was positively correlated with duration of post-operative mechanical ventilation (Pearson r = 0.83, p < 0.002) and total duration of post-operative respiratory support (Pearson r = 0.80, p = 0.004). DISCUSSION These results demonstrate that infants without a proximal TEF have a larger proximal esophagus and a greater angle of tracheal deviation which is directly correlated with the need for longer post-operative respiratory support. Additionally, these results demonstrate that MRI is a useful tool to assess the anatomy of EA/TEF.
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Affiliation(s)
- Kaitlyn T. Marks
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nara S. Higano
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meera Kotagal
- Division of General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paul S. Kingma
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Awowole IO, Ugowe OJ, Ubom AE, Sowande OA. Isolated esophageal atresia misdiagnosed as twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2022; 59:556-557. [PMID: 34532903 DOI: 10.1002/uog.24770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- I O Awowole
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ife, Osun State, Nigeria
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - O J Ugowe
- Department of Paediatrics and Child Health, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - A E Ubom
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - O A Sowande
- Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University, Ife, Osun State, Nigeria
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Foust AM, Zendejas B, Mohammed S, Meisner J, Zurakowski D, Staffa SJ, Jennings RW, Hamilton TE, Callahan MJ. Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia. Pediatr Radiol 2022; 52:468-476. [PMID: 34845501 DOI: 10.1007/s00247-021-05228-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/19/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radiographic assessment of esophageal growth in long-gap esophageal atresia while on traction and associated traction-related complications have not been described. OBJECTIVE To demonstrate how chest radiography can estimate esophageal position while on traction and to evaluate radiography's utility in diagnosing certain traction system complications. MATERIALS AND METHODS In this retrospective evaluation of portable chest radiographs obtained in infants with long-gap esophageal atresia who underwent the Foker process between 2014 and 2020, we assessed distances between the opposing trailing clips (esophageal gap) and the leading and trailing clips for each esophageal segment on serial radiographs. Growth during traction was estimated using longitudinal random-effects regression analysis to account for multiple chest radiograph measurements from the same child. RESULTS Forty-three infants (25 male) had a median esophageal gap of 4.5 cm. Median traction time was 14 days. Median daily radiographic esophageal growth rate for both segments was 2.2 mm and median cumulative growth was 23.6 mm. Traction-related complications occurred in 13 (30%) children with median time of 8 days from traction initiation. Daily change >12% in leading-to trailing clip distance demonstrated 86% sensitivity and 92% specificity for indicating traction-related complications (area under the curve [AUC] 0.853). Cumulative change >30% in leading- to trailing-clip distance during traction was 85% sensitive and 85% specific for indicating traction complications (AUC 0.874). CONCLUSION Portable chest radiograph measurements can serve as a quantitative surrogate for esophageal segment position in long-gap esophageal atresia. An increase of >12% between two sequential chest radiographs or >30% increase over the traction period in leading- to trailing-clip distance is highly associated with traction system complications.
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Affiliation(s)
- Alexandra M Foust
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | | | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Boston, MA, 02115, USA
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Castro PT, Fazecas T, Matos APP, Ribeiro G, Araujo Júnior E, Werner H. Concomitant fetal duodenal and esophageal atresia: three-dimensional reconstruction from magnetic resonance imaging. Ultrasound Obstet Gynecol 2022; 59:277-278. [PMID: 34931717 DOI: 10.1002/uog.24837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- P T Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - T Fazecas
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - A P P Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - G Ribeiro
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - H Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
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Kassif E, Weissbach T, Kushnir A, Shust-Barequet S, Elkan-Miller T, Mazkereth R, Weissmann-Brenner A, Achiron R, Weisz B. Esophageal atresia and tracheoesophageal fistula: prenatal sonographic manifestation from early to late pregnancy. Ultrasound Obstet Gynecol 2021; 58:92-98. [PMID: 32304613 DOI: 10.1002/uog.22050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Esophageal atresia and/or tracheoesophageal fistula (EA/TEF) remains one of the most frequently missed congenital anomalies prenatally. The aim of our study was to elucidate the sonographic manifestation of EA/TEF throughout pregnancy. METHODS This was a retrospective study of data obtained from a tertiary center over a 12-year period. The prenatal ultrasound scans of fetuses with EA/TEF were assessed to determine the presence and timing of detection of three principal signs: small/absent stomach and worsening polyhydramnios, both of which were considered as 'suspected' EA/TEF, and esophageal pouch, which was considered as 'detected' EA/TEF. We assessed the yield of the early (14-16 weeks' gestation), routine mid-trimester (19-26 weeks) and third-trimester (≥ 27 weeks) anomaly scans in the prenatal diagnosis of EA/TEF. RESULTS Seventy-five cases of EA/TEF with available ultrasound images were included in the study. A small/absent stomach was detected on the early anomaly scan in 3.6% of fetuses scanned, without a definitive diagnosis. On the mid-trimester scan, 19.4% of scanned cases were suspected and 4.3% were detected. On the third-trimester anomaly scan, 43.9% of scanned cases were suspected and 33.9% were detected. An additional case with an esophageal pouch was detected on magnetic resonance imaging (MRI) in the mid-trimester and a further two were detected on MRI in the third trimester. In total, 44.0% of cases of EA/TEF in our cohort were suspected, 33.3% were detected and 10.7% were suspected but, eventually, not detected prenatally. CONCLUSIONS Prenatal diagnosis of EA/TEF on ultrasound is not feasible before the late second trimester. A small/absent stomach may be visualized as early as 15 weeks' gestation. Polyhydramnios does not develop before the mid-trimester. An esophageal pouch can be detected as early as 22 weeks on a targeted scan in suspected cases. The detection rates of all three signs increase with advancing pregnancy, peaking in the third trimester. The early and mid-trimester anomaly scans perform poorly as a screening and diagnostic test for EA/TEF. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Kassif
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Weissbach
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shust-Barequet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Elkan-Miller
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Mazkereth
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Weissmann-Brenner
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Castro P, Werner H, Matos APP, Macedo N, Marinho PRS, Araujo Júnior E. Dynamic study by magnetic resonance imaging in evaluation of fetal esophageal atresia. Ultrasound Obstet Gynecol 2020; 56:949-951. [PMID: 31945249 DOI: 10.1002/uog.21976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Affiliation(s)
- P Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - H Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - A P P Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - N Macedo
- Gaffrée e Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - P R S Marinho
- Department of Obstetrics and Gynecology, Federal University of State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
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Liu SQ, Lv Y, Fang Y, Luo RX, Zhao JR, Luo RG, Li YM, Zhang J, Zhang PF, Guo JZ, Li QH, Han MX. Magnetic compression for anastomosis in treating an infant born with long-gap oesophageal atresia: A case report. Medicine (Baltimore) 2020; 99:e22472. [PMID: 33080683 PMCID: PMC7571919 DOI: 10.1097/md.0000000000022472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated. PATIENT CONCERNS A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios. DIAGNOSES A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray. INTERVENTIONS She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation. OUTCOMES The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia. LESSONS These results suggest that MCA is feasible and effective for treating LGEA in infants.
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Affiliation(s)
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
| | | | - Rui-Xue Luo
- Northwest Institute for Nonferrous Metal Research (NIN)
| | | | | | | | | | | | - Jin-Zhen Guo
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | - Qing-Hong Li
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
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Rohanizadegan M, Tracy S, Galarreta CI, Poorvu T, Buchmiller TL, Bird LM, Estroff JA, Tan WH. Genetic diagnoses and associated anomalies in fetuses prenatally diagnosed with esophageal atresia. Am J Med Genet A 2020; 182:1890-1895. [PMID: 32573094 DOI: 10.1002/ajmg.a.61639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022]
Abstract
Esophageal atresia (EA) is a congenital anomaly occurring in 2.3 per 10,000 live births. Due to advances in prenatal imaging, EA is more readily diagnosed, but data on the associated genetic diagnoses, other anomalies, and postnatal outcome for fetuses diagnosed prenatally with EA are scarce. We collected data from two academic medical centers (n = 61). Our data included fetuses with suspected EA on prenatal imaging that was confirmed postnatally and had at least one genetic test. In our cohort of 61 cases, 29 (49%) were born prematurely and 19% of those born alive died in the first 9 years of life. The most commonly associated birth defects were cardiac anomalies (67%) and spine anomalies (50%). A diagnosis was made in 61% of the cases; the most common diagnoses were vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula with esophageal atresia, radial or renal dysplasia, and limb anomalies association (43%, although 12% met only 2 of the criteria), trisomy 21 (5%), and CHARGE syndrome (5%). Our findings suggest that most fetuses with prenatally diagnosed EA have one or more additional major anomaly that warrants a more comprehensive clinical genetics evaluation. Fetuses diagnosed prenatally appear to represent a cohort with a worse outcome.
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Affiliation(s)
- Mersedeh Rohanizadegan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina I Galarreta
- Department of Pediatrics, University of California, San Diego, California, USA
- Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Tabitha Poorvu
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lynne M Bird
- Department of Pediatrics, University of California, San Diego, California, USA
- Division of Genetics/Dysmorphology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Judy A Estroff
- Maternal Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Dall'Asta A, Grisolia G, Nanni M, Volpe N, Schera GBL, Frusca T, Ghi T. Sonographic demonstration of fetal esophagus using three-dimensional ultrasound imaging. Ultrasound Obstet Gynecol 2019; 54:746-751. [PMID: 30672651 DOI: 10.1002/uog.20221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility of antenatal direct visualization of normal and abnormal fetal esophagus using three-dimensional ultrasound (3D-US) with Crystal Vue rendering technology. METHODS Between February and April 2018, 3D-US volumes were collected from a non-consecutive series of singleton pregnancies, referred for clinically indicated detailed prenatal ultrasound at 19-28 weeks' gestation to one of two fetal medicine units in Italy. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Postprocessing with multiplanar mode was applied to orientate the volume and identify the esophagus. The region of interest was angled by approximately 30° to the spine and its thickness was adjusted in order to optimize visualization of the intrathoracic and intra-abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk in the coronal plane. Postnatal follow-up was available in all cases. RESULTS During the study period, 91 pregnancies met the inclusion criteria and were recruited. The study cohort included two pregnancies with suspicion of esophageal atresia due to suboptimal visualization of the stomach. Of the 89 cases with normal stomach on two-dimensional (2D) imaging, 3D-US with Crystal Vue rendering technology allowed direct evaluation of the whole course of the esophagus in 74 (83.1%). In the two cases with small or absent stomach bubble on 2D imaging, esophageal atresia was demonstrated antenatally on 3D Crystal Vue imaging and was confirmed postnatally. The mean time required for offline postprocessing and visualization of the esophageal anatomy was 4 min. CONCLUSIONS Using 3D-US with Crystal Vue rendering, it is possible to visualize antenatally the normal fetal esophagus and demonstrate presence of esophageal atresia. This should facilitate prenatal counseling and management of cases with suspected esophageal atresia. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Grisolia
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - M Nanni
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G B L Schera
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Lee Mongerson CR, Jennings RW, Zurakowski D, Bajic D. Quantitative MRI study of infant regional brain size following surgery for long-gap esophageal atresia requiring prolonged critical care. Int J Dev Neurosci 2019; 79:11-20. [PMID: 31563705 DOI: 10.1016/j.ijdevneu.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known regarding the impact of concurrent critical illness and thoracic noncardiac perioperative critical care on postnatal brain development. Previously, we reported smaller total brain volumes in both critically ill full-term and premature patients following complex perioperative critical care for long-gap esophageal atresia (LGEA). Our current report assessed trends in regional brain sizes during infancy, and probed for any group differences. METHODS Full-term (n = 13) and preterm (n = 13) patients without any previously known neurological concerns, and control infants (n = 16), underwent non-sedated 3 T MRI in infancy (<1 year old). T2-weighted images underwent semi-automated brain segmentation using Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS). Regional tissue volumes of the forebrain, deep gray matter (DGM), cerebellum, and brainstem are presented as absolute (cm3) and normalized (% total brain volume (%TBV)) values. Group differences were assessed using a general linear model univariate analysis with corrected age at scan as a covariate. RESULTS Absolute volumes of regions analyzed increased with advancing age, paralleling total brain size, but were significantly smaller in both full-term and premature patients compared to controls. Normalized volumes (%TBV) of forebrain, DGM, and cerebellum were not different between subject groups analyzed. Normalized brainstem volumes showed group differences that warrant future studies to confirm the same finding. DISCUSSION Both full-term and premature critically ill infants undergoing life-saving surgery for LGEA are at risk of smaller total and regional brain sizes. Normalized volumes support globally delayed or diminished brain growth in patients. Future research should look into neurodevelopmental outcomes of infants born with LGEA.
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Affiliation(s)
- Chandler Rebecca Lee Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
| | - Russell William Jennings
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
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Sakamoto N, Mitsuzuka K, Kanno Y, Hayashi M, Goto Y, Ueno S, Ishimoto H. Atypical Presentation of Duodenal Atresia Concomitant with Type-A Esophageal Atresia in Fetal Life: A Case Report. Tokai J Exp Clin Med 2019; 44:31-33. [PMID: 31250423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Abstract
Duodenal atresia concomitant with type-A esophageal atresia (DA + TA-EA) is rare. A pronounced enlargement of a closed loop of the upper gastrointestinal tract serves as an early clue for its prenatal detection. We describe an atypical case of DA + TA-EA in which the dilatation of the upper gastrointestinal tract remained mild. Ultrasonographic examination at 28 weeks of gestation showed mild polyhydramnios. Subsequent detailed sonographic and magnetic resonance imaging studies revealed a mildly enlarged stomach and duodenum that resembled a "double bubble," mild ascites, and polydactyly of the right thumb. Fetal abdominal circumference measurements were within normal range. A female neonate born at 36 weeks gestation did not show abdominal distension. DA + TA-EA was diagnosed based on clinical characteristics and X-ray studies of the neonate; the diagnosis was confirmed by surgery. Duodenoduodenostomy and gastrostomy in the first week of life and esophagoesophagostomy at six months of age were performed with satisfactory results, and the infant developed well. Prominent and/or increasing C-shaped fluid collection in the upper abdomen is a highly useful diagnostic sign for DA + TA-EA, but it is not applicable for all fetuses with this disease. Physicians should bear this caveat in mind to avoid diagnostic delays and initiate prompt postnatal therapy.
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Affiliation(s)
| | | | | | | | | | | | - Hitoshi Ishimoto
- Department of Obstetrics and Gynecology, Specialized Clinical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Venkatesh P. A Simple and Easy Technique for Imaging the Fetal Esophagus in the First, Second, and Third Trimesters Using the Transverse Section of the Esophagus in the Area Behind the Heart as a Reference Point. J Ultrasound Med 2018; 37:2863-2872. [PMID: 29663459 DOI: 10.1002/jum.14646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe and evaluate a simple technique of imaging the fetal esophagus, using the echogenic transverse section of the esophagus in the area behind the heart as a reference point, in all the 3 trimesters of pregnancy. METHOD This was a prospective cross-sectional study of ultrasound imaging of the esophagus in 2 groups of patients: the first group comprised women at 18 to 30 weeks' gestation (208 fetuses); the second group comprised women at 11 to 14 weeks' gestation (102 fetuses). Using a 3- to 5-MHz curvilinear transducer, the transverse section of the collapsed esophagus was imaged in the area behind the heart. The probe was rotated 90 degrees to identify the longitudinal section of the esophagus which was then traced along its entire length. RESULT This study shows that the collapsed, echogenic, transverse section of the esophagus was persistently seen in the area behind the heart, in more than 99% of fetuses in both the groups. It was a useful starting point to image the longitudinal section of the esophagus in both the groups, particularly in the 18 - 30 week group. Using this technique, the entire length of the esophagus could be traced in 92.3% of 18 - 30 week fetuses and 88.23% of the 11 - 14 week fetuses. CONCLUSION A collapsed transverse section of the esophagus was persistently and easily seen as a bright echogenic structure in the area behind the heart in more than 99% of fetuses in all 3 trimesters (in both the groups) and, therefore, was an ideal starting point to begin tracing the esophagus in its longitudinal axis.
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Maus J, Naegels S, Slabbynck H, De Waele L, Ruytjens I. The missing link. Acta Gastroenterol Belg 2018; 81:531-533. [PMID: 30645925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present a case of a 28-year old woman who presented with bizarre wheezing breath sounds on expiration and dysphagia, with unexplained significant dilation of the esophagus mimicking achalasia finally leading to the diagnosis of a very small congenital tracheoesophageal fistula (TEF). Congenital TEF is usually detected shortly after birth and is typically accompanied by esophageal atresia. Congenital TEF without esophageal atresia (H-type fistula) can be missed in early life and diagnosis may be postponed until adulthood due to subtle symptoms. Diagnosis is usually based upon a combination of esophagoscopy, bronchoscopy, barium esophagography and CT-scan. The only clue can be the finding of a significant dilated aperistaltic esophagus, with subsequent more detailed CT reconstruction revealing a very tiny H-type TEF. It is important to raise the awareness of small H-type TEF as a possible cause of achalasia-like esophageal dilation in adulthood and of very unusual and bizarre wheezing breath sounds.
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Affiliation(s)
- J Maus
- ZNA Middelheim, Department of Gastro-enterology
| | - S Naegels
- ZNA Middelheim, Department of Gastro-enterology
| | | | - L De Waele
- ZNA Middelheim, Department of Gastro-enterology
| | - I Ruytjens
- ZNA Middelheim, Department of Gastro-enterology
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Aguilera-Pujabet M, Gahete JAM, Guillén G, López-Fernández S, Martin-Giménez MP, Lloret J, López M. Management of neonates with right-sided aortic arch and esophageal atresia: International survey on IPEG AND ESPES members´ experience. J Pediatr Surg 2018; 53:1923-1927. [PMID: 29241961 DOI: 10.1016/j.jpedsurg.2017.11.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 11/20/2022]
Abstract
AIM The optimum surgical approach of neonates with right-sided aortic arch (RAA) and esophageal atresia (EA)/tracheoesophageal fistula (TEF) is still an unsolved question. In order to propose an operative algorithm in the era of endoscopic surgery, we performed an international survey to know the current practice between pediatric endoscopic surgeons. Two of the most important societies in endoscopic pediatric surgery were queried: the International Pediatric Endosurgery Group (IPEG) and the European Society of Paediatric Endoscopic Surgeons (ESPES). MATERIALS AND METHODS During December 2016, an anonymous online-based survey was sent to all IPEG and ESPES members, collecting data regarding perioperative management and surgical repair of EA/TEF with RAA. RESULTS 144 surgeons from 23 countries completed the questionnaire. 69.2% of respondents were IPEG members, 30.8% were ESPES members. 71.5% of members who answered the survey had more than 10years of surgical experience. A preoperative echocardiography was almost uniformly performed (93.1%). 31.9% of the surveyed surgeons had never treated an EA/TEF with RAA. The remaining 98 surveyed surgeons had managed 279 cases of EA/TEF with RAA. Thoracotomy was considered the preferred approach for 54.2% of the surgeons, and 51.9% chose a right-sided approach. When RAA was an intraoperative finding, 76% would perform a contralateral thoracotomy if difficulties arose. Thoracoscopy was preferred by 45.8% of surgeons. If RAA was suspected preoperatively, 63.1% preferred to attempt a left-sided thoracoscopy and only 24.2% would change their approach to a thoracotomy. If RAA was an intraoperative finding and a safe surgical repair could not be achieved through right-sided thoracoscopy, 51.5% of them chose to perform a left sided thoracoscopy, rather than convert to thoracotomy. CONCLUSIONS Preoperative echocardiography performed by experienced examiners helps in surgical planning. Preoperative diagnosis of RAA should not discourage thoracoscopic repair, which is increasingly becoming more popular for the correction of EA/TEF. In case of an unexpected intraoperative diagnosis of RAA or operative difficulties when approaching through the right side, thoracoscopy offers a less aggressive approach. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Monserrat Aguilera-Pujabet
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Jose Andres Molino Gahete
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Gabriela Guillén
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Sergio López-Fernández
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Marta Patricia Martin-Giménez
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Josep Lloret
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain.
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Abstract
BACKGROUND Gastric transposition is a relatively novel method of esophageal replacement. The purpose of this retrospective study was to assess the outcomes of long-gap esophageal atresia (LGEA) treated with esophageal replacement using primary gastric transposition in neonates. METHODS Between March 2008 and May 2015, 14 newborns with LGEA were treated in our hospital. They were all found to have gaps of over 3 cm at the time of the surgery and were diagnosed with LGEA. Primary gastric transposition was performed. They also underwent a gastric drainage procedure by pyloromyotomy. The nasogastric tube was removed if no anastomotic fistula was present and oral feeding was initiated. After initial recovery and discharge, the patients were evaluated with outpatient follow-ups or telephone follow-ups from 1 month after the surgery. RESULTS The mean age of the neonates at the time of the surgery was 32 hours (range, 4-96 h). The mean birth weight was 2550 g (range, 2100-3500 g). There were 2 deaths in this series of patients due to respiratory failure or withdrawal of treatment by the parents, with a mortality rate of 14.3%. Seven of the neonates developed unilateral or bilateral severe pneumonia. Early anastomotic leak occurred in 3 cases and anastomotic strictures occurred in 4 cases. These 4 neonates were able to eat a fairly normal diet after esophageal balloon dilation. Gastroesophageal reflux occurred in 7 of 12 cases. Feeding multiple small meals and postural support for positioning and feeding were instructed for these 7 cases. Subsequently, the symptoms alleviated and they had no additional surgical therapy. None of the neonates had delayed gastric emptying or gastric retention. CONCLUSION Primary gastric transposition may be a rewarding reconstructive option in the treatment of LGEA.
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Affiliation(s)
| | | | - Juan Ma
- Anesthesiology, Xuzhou Children's Hospital, Xuzhou, China
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24
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Chatzizacharias NA, Lakhoo K. Diagnosis of type C esophageal atresia despite the "successful" positioning of a nasogastric tube. Minerva Pediatr 2016; 68:76-78. [PMID: 26864721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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25
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Muensterer OJ, Berdon WE. From Vogt to Haight and Holt to now: the history of esophageal atresia over the last century. Pediatr Radiol 2015; 45:1230-5. [PMID: 25666441 DOI: 10.1007/s00247-015-3276-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/20/2014] [Accepted: 01/02/2015] [Indexed: 11/26/2022]
Abstract
Esophageal atresia was first classified by the Boston Children's Hospital radiologist Edward Vogt in 1929 and has been a major challenge in its characterization and management ever since. It defied all attempts at repair until University of Michigan thoracic surgeon Cameron Haight's first successful fistula ligation and primary esophageal anastomosis in 1941. Haight worked with the pediatric radiologist John Holt. This historical review describes advances in pre- and postnatal diagnosis.
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Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, University Medicine Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany,
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26
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Liszewski MC, Bairdain S, Buonomo C, Jennings RW, Taylor GA. Imaging of long gap esophageal atresia and the Foker process: expected findings and complications. Pediatr Radiol 2014; 44:467-75. [PMID: 24366604 DOI: 10.1007/s00247-013-2847-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/13/2013] [Accepted: 11/21/2013] [Indexed: 01/21/2023]
Abstract
Long gap esophageal atresia (EA) is characterized by esophageal segments that are too far apart for primary anastomosis. Surgical repair utilizing interposition grafts or gastric transposition are often employed. The Foker staged lengthening procedure is an alternative surgical method that utilizes continuous traction on the esophagus to induce esophageal growth and allow for primary esophageal anastomosis. This pictorial review presents the step-by-step radiographic evaluation of the Foker procedure and illustrates the radiographic findings in the most commonly encountered complications in our cohort of 38 patients managed with this procedure from January 2000 to June 2012.
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Affiliation(s)
- Mark C Liszewski
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA,
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27
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Sghairoun N, Ben Slama A, Sahli S, Gasmi M, Hamzaoui M. [Esophageal atresia associated with hypertrophic pyloric stenosis]. Tunis Med 2013; 91:551-552. [PMID: 24227515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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28
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Abstract
The diagnosis of oesophageal atresia (OA) is usually made soon after birth. Two diagnostic criteria are failure to pass a nasogastric (NG) tube and a chest radiograph demonstrating a curled NG tube in the upper oesophageal pouch. A 6-day-old neonate was referred to our institution with persistence of symptoms following exclusion of the diagnosis of OA on the basis of an NG tube radiologically confirmed to reach the stomach. Persistent oxygen desaturations and copious salivation led to further investigations, and a delayed diagnosis of oesophageal atresia and tracheo-oesophageal fistula was made. Radiological demonstration of an NG tube reaching the stomach does not exclude the diagnosis of oesophageal atresia and can be falsely reassuring and lead to diagnostic delay.
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Affiliation(s)
- Kamal Kuti
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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29
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Quarello E, Saada J, Desbriere R, Rousseau V, De Lagausie P, Benachi A. Prenatal diagnosis and evaluation of defect length in esophageal atresia using direct and indirect (tracheal print) signs. Ultrasound Obstet Gynecol 2011; 38:225-228. [PMID: 21105018 DOI: 10.1002/uog.8888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 05/30/2023]
Abstract
The prenatal diagnosis of esophageal atresia is challenging. The length of the defect of the esophageal atretic portion is one of the parameters affecting outcome and prenatal evaluation of this length has not, to our knowledge, been described previously. We report on seven fetuses assessed prospectively which were suspected to have esophageal atresia. Targeted ultrasound examination of both fetal cervical and thoracic structures was performed in each case in order to assess prenatally the atretic portion. The length of the defect was assessed both directly, by visualizing the interruption of the hyperechoic lines representing the walls of the esophagus in a mid-sagittal view (n = 4), and indirectly, by means of the 'tracheal print' (n = 5). Both methods were used in three cases. Prenatal results were compared with postnatal or postmortem findings. The prenatal diagnosis of esophageal atresia was made correctly in six of the seven cases and in all of these there was concordance between prenatal and postnatal estimates of the esophageal defect lengths. Direct or indirect sonographic assessment of the esophagus in cases of suspected prenatal esophageal atresia improves the specificity of its diagnosis and aids prenatal evaluation.
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Affiliation(s)
- E Quarello
- Unité d'Échographies Obstétricales, Pôle Parents Enfants, Hôpital Saint Joseph, Marseille, France.
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30
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Schuurman MJ, Robben SG, Been JV. A congenital anomaly in a preterm newborn. BMJ 2010; 340:b5241. [PMID: 20071436 DOI: 10.1136/bmj.b5241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marijn J Schuurman
- Department of Paediatrics, Maastricht University Medical Centre, 6202 AZ Maastricht, Netherlands
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31
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Bober K, Musialik-Swietlińska E, Adamiec-Poniewierka E, Pajak J, Bielecki I, Koszutski T, Wiecek-Włodarska D, Goc B, Szydłowski L, Swietliński J. Tracheal agenesis: perioperative management of one stage correction. Paediatr Anaesth 2008; 18:982-3. [PMID: 18811835 DOI: 10.1111/j.1460-9592.2008.02586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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32
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Gurskas P, Ivanauskas A. [Spontaneous recanalisation of the esophagus]. Medicina (Kaunas) 2008; 38 Suppl 2:69-71. [PMID: 12560626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Main problem in treating newborns with congenital esophageal atresia is a long gap between esophageal segments. There are many publications that describe various techniques of esophageal anastomosis. In our report we observed spontaneous racanalisation of the esophagus. This study reports 3 similar clinical pictures of patients, received and treated in our clinics for III-b type oesophageal atresia (esophageal atresia with distal tracheoesophageal fistula). All newborns were operated, two patients underwent palliative procedures, leaving a diastasis between esophageal pouches, and lining a vicryl string between oesophageal ends; and in one case attempt of primary oesophageal anastomosis turned in to leakage of anastomosis and mediastinitis. All patients were feeded via gastrostomy and in the period of 20-29 th postoperative day revealed regurgitation symptoms. Evaluation of laboratory and instrumental findings lead us to conclusion, that bypass of the oesophagus was reestablished. The thred canal connecting both esophageal pouches was found. Dilatation was introduced to all patients, two of them required subsequent resection of esophageal stricture. CONCLUSIONS. Successful primary esophageal anastomosis - the best choice. Review of the literature allowed authors to detect few criterion that influenced canal formation: open lumen of the esophagus, "vicryl string" and traction. Method of "thred canal formation" is acceptable in cases of inconceivable primary esophageal anastomosis or esophageal anastomosis, complicated with leakage and mediastinitis.
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Affiliation(s)
- Pranas Gurskas
- Clinic of Pediatric Surgery, Vilnius University, Santariskiu 7, 2600 Vilnius, Lithuania
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Abstract
OBJECTIVES To assess the accuracy of the prenatal ultrasound finding of subjectively small/absent stomach bubble in the prenatal diagnosis of tracheo-oesophageal fistula and oesophageal atresia (TOF/OA). METHODS A retrospective study of prenatal ultrasound scans showing small/absent stomach bubble was carried out between 1st January 1994 and 31st December 2003. RESULTS There were 62 cases with prenatally suspected (n = 40) and/or post-natally diagnosed (n = 22) TOF/OA. Among the 40 cases of prenatally suspected TOF/OA 15 were thought to be isolated and 25 non-isolated. Of the 15 suspected isolated cases, 7 were normal and 8 had TOF/OA (5 isolated + 3 TOF/OA with another anomaly) at delivery. Among the 25 cases of prenatally suspected non-isolated TOF/OA, there was confirmation in only two cases, in the remaining 23 cases other anomalies were confirmed but TOF/OA was not present.Twenty-two babies with TOF/OA were identified in whom there had been no prenatal ultrasound suspicion on ultrasound scanning. Six had isolated TOF/OA and 16 had non-isolated TOF/OA. CONCLUSION Of the 32 cases of confirmed TOF/OA,10 (31%) were suspected prenatally. If the TOF/OA was an isolated anomaly (11 cases), the prenatal detection rate was 45%. Interpretation of ultrasound findings suspicious of TOF/OA requires caution, particularly, when there are associated multiple anomalies on scan.
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Affiliation(s)
- M Choudhry
- Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford OX3 9DU, UK
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34
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Lima M, De Biagi L, Gargano T, Ruggeri G, Libri M, Tani G, De Rose R, Baroncini S, Gentili A. [Thoracoscopic treatment of oesophageal atresia]. Pediatr Med Chir 2007; 29:262-266. [PMID: 18402395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Advancements in minimally invasive surgery in newborns have allowed even the most complex neonatal procedures to be approached using these techniques. Other authors have demonstrated its efficacy in the treatment of the esophageal atresia with distal fistula. METHODS We report our experience based on the thoracoscopic repair of esophageal atresia with distal fistula in two newborns. Birth weights were 2.800 g and 2.300 g respectively. The patients were intubated endotracheally and placed in a left prone position. Four trocars were inserted: the first one of 5 mm was positioned in the fifth intercostal space for the camera, the other two of 3 mm were positioned in the fourth intercostal space on the anterior and posterior axillary line respectively for the operative instruments. The last trocar of 3 mm was inserted in the third intercostal space on the anterior axillary line for the lung retractor. CO2 was insufflated at a pressure of 8 mm Hg and a flow of 0.5 L/min. The fistula was first isolated then ligated and cut with scissors. The proximal esophagus was opened and an anastomosis was made over a 6F or 8F nasogastric tube with interrupted 4-0 Vicryl sutures. A tube chest was placed through the lower trocar site with the tip near the anastomosis. RESULTS These two procedures were free of neither intraoperative nor post-operative complications. Feeding by nasogastric tube was started after a mean of 4 days. Barium swallow made on day 7 demonstrated no leakage and no stenosis of the anastomosis. Total oral feeding was possible after 8 days. Mean hospitalization was 14 days. CONCLUSION This initial report shows, as demonstrated by the experience since 1999 by other authors, that the thoracoscopic esophageal repair in the newborns is technically feasible and, thanks to a magnified vision, it allows to abtain a good isolation of the esophagus and of the tracheo-esophageal fistula respecting the anatomical structures. Moreover the advantages are in terms of exposure and esophageal length, avoiding the significant short and long-term morbidity associated with thoracotomy.
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Affiliation(s)
- M Lima
- Chirurgia Pediatrica, Università degli Studi, Bologna.
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35
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Abstract
OBJECTIVE Ultra-long gap (> 3.5 cm) esophageal atresias (ULGEA) are very rare congenital disorders usually treated by esophageal substitution. Since the introduction of Foker's elongation technique for primary anastomosis, there is much controversy over whether the Foker method or esophageal substitution results in a better outcome. Until now, there was only one series, which had been reported by Foker himself. We therefore present the outcome 2.5 years after one of the first children was operated on with the Foker method in Europe (2003). PATIENT AND METHOD A premature child (1820 g, 33 + 4 gestational week) born with isolated ULGEA (6-cm gap length/30.5-cm body length) was treated with the Foker technique. We present a critical review of the course together with any complications that can help in the clinical evaluation of the new technique. RESULTS AND CONCLUSION Three thoracotomies and 5 dilating procedures over a period of 3 months were necessary to achieve primary anastomosis. Two major complications occurred (anastomotic leak and subsequent stricture). The boy was under mechanical ventilation for a total of 15 days. The Foker method seems to be quite feasible and quickly results in the expected primary anastomosis. The result in this single case is excellent.
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Affiliation(s)
- K Paya
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
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36
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Abstract
OBJECTIVE Prenatal diagnosis of esophageal obstruction is believed to improve the outcome for the affected newborn. However, the prenatal detection rate is only 10-40%, the diagnosis is usually not made before the third trimester and the false-positive rate has been high. This study investigated the prenatal detection rate and time of prenatal diagnosis at our center and its influence on outcome. In addition, incidence, detection rate and accuracy of the diagnosis in a large non-selected population were determined. METHODS All cases diagnosed pre- or postnatally with esophageal obstruction and examined prenatally by ultrasound at the National Center for Fetal Medicine in Norway during 1987-2004 were evaluated. RESULTS Of 48 cases with esophageal obstruction, 21 (44%) were diagnosed prenatally (median, 32 + 0 weeks). All 21 had a small or empty stomach, 20/21 (95%) had polyhydramnios and 9/21 (43%) had a visible esophageal pouch. Associated anomalies were present in 38/48 cases (79%). The karyotype was abnormal in 11/48 cases (23%). Ten (21%) pregnancies with lethal fetal conditions were terminated. Two fetuses died in utero. Ten infants with associated anomalies died within 3 months after birth. The 26/48 (54%) survivors included 16/21 cases with a prenatal diagnosis of esophageal obstruction and 9/10 cases with isolated esophageal obstruction. CONCLUSIONS The clinical signs of polyhydramnios were the most important factors for prenatal detection of esophageal obstruction. Consequently, the time of diagnosis was late and the detection rate was low (44%). An increased awareness of the possibility of esophageal obstruction, leading to targeted examinations whenever the suspicion is raised during pregnancy, might improve the prenatal detection rate and thereby provide a possibility to improve the outcome. Of the cases with isolated esophageal obstruction, 90% survived, irrespective of prenatal diagnosis.
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Affiliation(s)
- A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim University Hospital, Norwegian University of Science and Technology, Trondheim, Norway.
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Sri Paran T, Decaluwe D, Corbally M, Puri P. Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up. Pediatr Surg Int 2007; 23:647-51. [PMID: 17516075 DOI: 10.1007/s00383-007-1925-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2007] [Indexed: 02/06/2023]
Abstract
The management of a newborn with pure oesophageal atresia continues to be challenging. We started treating babies with pure oesophageal atresia by delayed primary anastomosis in 1977. The purpose of this study was to review the long-term outcome in infants with pure oesophageal atresia (EA) treated by delayed primary anastomosis with special emphasis on gastroesophageal reflux (GOR) related morbidity. The medical charts of all patients treated by delayed primary anastomosis between 1977 and 2004 were retrospectively reviewed. All survivors were followed up with completion of a questionnaire and personal/phone interviews. There were 26 patients in total admitted during the 27-year study period with the diagnosis of pure oesophageal atresia. Three died prior to surgery due to associated anomalies; two had almost no distal oesophageal segment and underwent oesophageal replacement surgery. The remaining 21 children were treated with delayed primary anastomosis and made up our study group. There were four deaths (19%) in this group, and all were prior to 1980. The median gestational age was 35.5 weeks and the median birth weight was 2.6 kg; median initial gap was 3.7 cm and median preoperative gap was 1.5 cm; median age at operation was 80 days and the median hospital stay was 5.5 months. The median follow-up period was 13.5 years. Fourteen children (66%) developed symptomatic gastroesophageal reflux and nine of these needed fundoplication (43%). Sixteen children developed strictures at the anastomotic site; ten responded to repeated dilatations while six needed resection and reanastomosis. At the time of this study, 15 out of the 17 survivors (88%) were on normal diet with no respiratory problems and 2 (12%) were dependent on gastrostomy feeds. Our long-term follow-up data shows that the delayed primary anastomosis provides excellent functional results in patients born with pure oesophageal atresia. The high incidence of gastroesophageal reflux and associated morbidity requires early intervention to prevent ongoing feeding problems due to oesophagitis and stricture formation.
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Affiliation(s)
- Thambipillai Sri Paran
- Children's Research Centre, Our Lady's Hospital for Children, University Hospital, Crumlin, Dublin 12, Ireland
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38
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Abstract
Diverticulum of Kommerell is an outpouching from the descending aorta that, along with an aberrant subclavian artery and ductus arteriosus, may form a vascular ring compressing the trachea and/or the esophagus. It has been reported as an incidental finding as well as the cause of persistent dysphagia, cough, "asthma," or airway compromise at various ages but has never been reported as a cause of esophageal atresia in a newborn. We present a newborn with diverticulum of Kommerell, a vascular ring, and esophageal atresia.
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Affiliation(s)
- T Kanwal
- McMaster Children's Hospital, 1200 Main Street West, L8N3Z5, Hamilton, Ontario, Canada.
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39
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Abstract
Delay in the diagnosis of esophageal atresia (EA) is rare. We present a child with EA and distal tracheoesophageal fistula who was diagnosed 9 days from birth after a contrast study performed at the referring hospital. This article aims to highlight the potential hazards of using contrast to diagnose EA.
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Affiliation(s)
- Milan Gopal
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, BS2 8BJ Bristol, UK
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40
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Shono T, Taguchi T, Suita S, Nakanami N, Nakano H. Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis. J Pediatr Surg 2007; 42:681-4. [PMID: 17448765 DOI: 10.1016/j.jpedsurg.2006.12.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Cloacal malformations are rare anomalies, occurring in females, and in which they demonstrate a single perineal orifice for urethra, vagina, and rectum. Prenatal ultrasonograms (US) of cloacal malformations sometimes show ascites, hydrocolpos, and hydronephrosis. We herein describe the characteristic prenatal US and magnetic resonance imaging (MRI) findings of the cloacal malformations associated with meconium peritonitis. METHODS The pre- and postnatal records of 11 newborn patients with cloacal malformations, treated in our hospital from 1988 to 2004, were reviewed. All fetuses underwent prenatal US by experienced obstetricians, whereas in addition, fetal MRI was performed in 1 patient. RESULTS The prenatal US and/or MRI findings showed fetal ascites, a multicystic pelvic mass, oligohydramnios, and bilateral hydronephrosis in 5 of 11 patients with cloacal malformations. In these 5 cases, postnatal examinations showed associated hydrocolpos, hydrometrocolpos, and bilateral hydronephrosis; furthermore, 4 of these 5 cases also showed meconium peritonitis at laparotomy. CONCLUSIONS The prenatal US and MRI findings, showing fetal ascites, multicystic pelvic mass, bilateral hydronephrosis, and oligohydraminios are highly suggestive of the cloacal malformations associated with meconium peritonitis.
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Affiliation(s)
- Takeshi Shono
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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41
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Abstract
A "gasless abdomen" in babies with esophageal atresia (EA) has traditionally been thought to imply absence of a distal tracheoesophageal fistula (TEF). We present 3 neonates with a provisional diagnosis of EA, who had a gasless abdomen on an initial x-ray taken within the first 4 hours of life. These children were subsequently shown to have gas in the stomach associated with a distal TEF. Two children were examined on subsequent repeat x-ray of the abdomen, when gas was demonstrated in the stomach. Another child had a laparotomy for a gastrostomy when a distended stomach was found. This baby went on to have a thoracotomy and a routine repair of the distal TEF and an esophageal anastamosis. Based on our data of 65 cases of EA and distal TEF, it is recommended that an x-ray of the abdomen is repeated before surgery is undertaken if the gasless abdomen is documented during the first 4 hours of life.
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Affiliation(s)
- Malenka M Gedicke
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, BS2 8BJ Bristol, UK
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42
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Khan KM, Foker JE. Use of high-resolution endoscopic ultrasonography to examine the effect of tension on the esophagus during primary repair of long-gap esophageal atresia. Pediatr Radiol 2007; 37:41-5. [PMID: 17043852 DOI: 10.1007/s00247-006-0333-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 08/24/2006] [Accepted: 09/07/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have shown that tension applied to the esophageal pouches in long-gap esophageal atresia allows primary repair without necessity for intestinal or gastric transposition. OBJECTIVE To determine whether the mural structure of the upper esophageal pouch is altered by tension. MATERIALS AND METHODS We examined the esophagus with high-resolution endoscopic ultrasonography. The upper pouch was examined before traction and the upper and lower esophagus were examined after primary repair. Of 11 patients examined, 7 were male. At initial surgery the age, weight and length of the patients (mean +/- SD) were 118 +/- 88 days, 4.7 +/- 1.2 kg and 54 +/- 4 cm, respectively. The gap length was 4.7 +/- 1.1 cm. RESULTS The pretraction measurement of the muscularis propria of the upper pouch was similar to the postanastomotic measurement of the upper esophagus, and there was no statistically significant difference from the lower esophageal segments after anastomosis: 0.83 +/- 0.19, 0.80 +/- 0.15 and 0.81 +/- 0.22 mm, respectively (P = 0.90). The thickness of combined mucosa and submucosa was also very similar in all three measurements, respectively: 0.93 (0.21) mm vs. 1.06 (0.08) mm vs. 1.0 (0.11) mm (P = 0.14). CONCLUSION The layers of the upper esophageal pouch are preserved in infants with esophageal atresia in whom esophageal length is increased with tension.
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Affiliation(s)
- Khalid M Khan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, MMC 185, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
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Khan KM, Sabati AA, Kendall T, Foker JE. The effect of traction on esophageal structure in children with long-gap esophageal atresia. Dig Dis Sci 2006; 51:1917-21. [PMID: 16977508 DOI: 10.1007/s10620-006-9169-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Accepted: 11/28/2005] [Indexed: 12/23/2022]
Abstract
We examined the esophageal structure in children who underwent traction to achieve primary repair of long-gap esophageal atresia. High-resolution ultrasound was used to compare thickness of the proximal and distal esophagus in children who had traction to achieve primary repair (n=15) to cases of esophageal atresia with shorter gaps that did not require traction (n=8). The muscularis propria of the upper esophagus was thicker in the traction compared to the non-traction group, though not statistically significant (respectively, 0.79 (0.18) mm vs. 0.71 (0.16) mm; p=0.29), measurements were similar for the lower esophagus (respectively, 0.79 (0.21) mm vs. 0.75 (0.13) mm; p=0.64). Combined mucosa and submucosa was very similar in both groups for the upper (respectively, 1.03 (0.15) mm vs. 1.04 (0.16) mm; p=0.95) and lower esophagus (respectively, 1.09 (0.23) mm vs. 1.01 (0.13) mm; p=0.37). The thickness of individual mural layers is maintained after increasing esophageal length with traction.
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Affiliation(s)
- Khalid M Khan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, MMC 185, 420 Delaware St SE, Minneapolis, MN 55455, USA.
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44
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Peh G, Chow P, Haddad M, Godambe S. Delayed presentation of tracheomalacia in an infant with long-gap esophageal atresia and distal tracheoesophageal fistula and a right aortic arch. J Pediatr Surg 2006; 41:1788-90. [PMID: 17011296 DOI: 10.1016/j.jpedsurg.2006.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Abstract
We present a case of horseshoe lung (HL) and esophageal atresia suspected prenatally on US imaging and confirmed with fetal MRI. Prenatal diagnosis of HL and esophageal atresia allowed for prenatal counseling and informed parental decisions.
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Affiliation(s)
- Shlomit Goldberg
- Radiology Department, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Tracheoesophageal fistula (TEF) or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bron-choesophageal fistula is usually associated with eso-phageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.
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Affiliation(s)
- Koichi Nagata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Yokohama 224-8503, Japan.
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Vargün R, Fitöz S, Yagmurlu A. Comment on evaluation of neonates with esophageal atresia using chest CT scan. Pediatr Surg Int 2006; 22:300-1. [PMID: 16341731 DOI: 10.1007/s00383-005-1613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2005] [Indexed: 11/26/2022]
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Smilari P, La Spina M, Salvo V, Romeo MG, Sanges G. [Esophageal atresia and malformative association. Clinical contribution]. Minerva Pediatr 2005; 57:289-96. [PMID: 16205614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Esophageal atresia (EA) is a congenital malformation with an incidence of 1/3,000-3,500 live birth, due to anomalies of the foregut. Although an interstitial deletion of chromosome 17 (q22q23.3) has been identified, the etiology seems to be multifactorial and not only genetic. The aim of this retrospective study is to evaluate the association of EA with chromosomal pathologies and/or malformation syndromes. METHODS The authors report 18 cases of EA admitted to the UTIN of the Pediatric Department, University of Catania, between January 1998 and January 2001, and discuss the phases of preoperative stabilization, the operation, postoperative complications and the follow-up at 12 months. RESULTS The results obtained concerning the association of EA with chromosomal diseases and malformation syndromes are described in the ''Results'' section of the paper. CONCLUSIONS The results obtained, notwithstanding the low number of patients, show that the association of EA with chromosomal pathologies and malformation syndromes is relevant both from a numerical and prognostic point of view in comparison to the data published in the literature.
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Affiliation(s)
- P Smilari
- Unità di Terapia Intensiva e Subintensiva Neonatale (UTIN), Università degli Studi di Catania, Azienda Policlinico, Catania
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Yagel S, Sonigo P, Rousseau V, Sarnacki S, Cohen S, Benachi A. Esophageal atresia diagnosed with three-dimensional ultrasonography. Ultrasound Obstet Gynecol 2005; 26:307-8. [PMID: 16116568 DOI: 10.1002/uog.1982] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah University Hospital--Mt Scopus, Jerusalem, Israel.
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