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Tracheal left mainstem bronchus and obstructive gastric mucosal intussusception associated with esophageal atresia
C J Tan1, D C Aronson, S Ekkelkamp
1Pediatric Surgical Centre of Amsterdam, Free University Hospital, Amsterdam, The Netherlands.
Insights
A child with esophageal atresia experienced a rare tracheal bronchus and gastric intussusception. Surgical correction resolved both conditions, suggesting a link between intussusception and esophageal atresia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pulmonology
Background:
- Esophageal atresia and tracheoesophageal fistula are congenital anomalies often presenting with complex surgical challenges.
- Gastric mucosal intussusception is a rare cause of gastric outlet obstruction, with its etiology debated in the literature.
Observation:
- A pediatric patient with esophageal atresia and tracheoesophageal fistula developed a tracheal left mainstem bronchus and gastric outlet obstruction.
- The tracheal bronchus led to persistent atelectasis and ventilation dependency, while gastric mucosal intussusception caused obstructive symptoms.
Findings:
- Bronchography and bronchoscopy revealed a tracheal left mainstem bronchus, which was surgically reimplanted into the carina, resolving atelectasis.
- Esophagogastroscopy identified gastric mucosal intussusception causing gastric outlet obstruction; resection of the intussuscepted fold and an antireflux procedure led to satisfactory recovery.
Implications:
- This case highlights the potential association between gastric mucosal intussusception and esophageal atresia, challenging previous hypotheses linking it solely to gastrostomy tubes.
- Successful surgical management of both congenital airway anomalies and gastric complications underscores the importance of comprehensive care in affected children.
Abstract:
A tracheal left mainstem bronchus and gastric outlet obstruction owing to gastric mucosal intussusception occurred in a child who had esophageal atresia and tracheoesophageal fistula. Bronchography and bronchoscopy, indicated because of persisting atelectasis and ventilation dependency, showed a tracheal left mainstem bronchus. The atelectasis disappeared after reimplantation of the left mainstem bronchus into the carina. Feeding problems and recurrent pulmonary infections complicated the postoperative course. Radiographic imaging and esophagogastroscopy showed severe reflux esophagitis and a prepyloric mass that consisted of a gastric mucosal intussusception. Subsequent gastrotomy and resection of the intussuscepted mucosal fold relieved the gastric outlet obstruction. An antireflux procedure was performed simultaneously. The child recovered satisfactorily. It is suggested that gastric mucosal intussusception may be associated with esophageal atresia rather than with the presence of a gastrostomy tube, as has been proposed in the literature.