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Transient mega-esophagus in a neonate with congenital diaphragmatic hernia
I R Makhoul1, G Shoshany, T Smolkin
1Department of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Bat-Galim 31096, Haifa, Israel. makhoul@rambam.health.gov.il
Insights
Esophageal dilatation in neonates is rare but can occur with congenital diaphragmatic hernia. This condition often resolves with conservative management, as seen in this case study.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Gastroenterology
Background:
- Esophageal dilatation (ED) is a rare condition in neonates.
- Congenital diaphragmatic hernia (CDH) is a serious birth defect affecting lung development.
Observation:
- A term neonate post-CDH repair presented with ED detected on chest radiograph.
- Swallow studies revealed ED, a sub-diaphragmatic stomach, and later, gastroesophageal reflux with a small hiatus hernia.
Findings:
- The fetal herniated stomach likely caused gastroesophageal junction obstruction, leading to ED and concealed reflux.
- The infant showed adequate thriving on enteral feeding despite the initial findings.
Implications:
- Highlights the association between ED and CDH, emphasizing the need for clinical awareness.
- Suggests a benign course for ED associated with CDH when managed conservatively.
Abstract:
Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management.