Arda Irfan Serdar, Guney Lutfi Hakan, Coskun Mehmet, Hiçsönmez Akgün
Department of Pediatric Surgery, Baskent University Faculty of Medicine, 06490 Bahçelievler Ankara, Turkey.
J Pediatr Surg. 2005 Apr;40(4):E21-3. doi: 10.1016/j.jpedsurg.2005.01.021.
A 10-year-old boy who had previously undergone surgery for tetralogy of Fallot, pulmonary atresia, and ventricular septal defect was admitted with difficulty in swallowing and significant failure to thrive. His history included that he had 2 angiographically detected aberrant pulmonary arteries extending from the descending aorta to the right and left lungs, respectively. Both collaterals had been ligated during the corrective surgery; however, early postoperative evaluation revealed that the vessel that crossed behind the esophagus to the left lung had become recanalized. Coil embolization was performed to occlude this collateral. The patient had begun to develop swallowing difficulties 2 years after the embolization. Esophagography revealed a significant stricture in the middle of the esophagus, just anterior to the location of the coil in the vessel behind. The patient underwent a program of esophageal dilatation. This was successful, and he regained normal swallowing ability. To our knowledge, no similar case of esophageal stenosis has been reported in the English literature. We believe that inflammation surrounding the coiled aberrant artery, presumably caused by injury during the corrective surgery and resulting in hemorrhage, led to fibrosis around the vessel. This fibrosis also involved the adjacent esophageal wall, thus causing progressive stenosis.
一名10岁男孩曾接受法洛四联症、肺动脉闭锁及室间隔缺损手术，因吞咽困难及严重发育不良入院。他的病史包括血管造影检测到分别从降主动脉延伸至右肺和左肺的2条异常肺动脉。在矫正手术期间，两条侧支血管均已结扎；然而，术后早期评估显示，穿过食管后方至左肺的血管已再通。进行了弹簧圈栓塞以闭塞该侧支血管。栓塞术后2年，患者开始出现吞咽困难。食管造影显示食管中部有明显狭窄，正好位于后方血管中弹簧圈所在位置的前方。患者接受了食管扩张治疗。治疗成功，他恢复了正常吞咽能力。据我们所知，英文文献中尚未报道过类似的食管狭窄病例。我们认为，围绕盘绕的异常动脉的炎症可能是由矫正手术期间的损伤导致出血引起的，进而导致血管周围纤维化。这种纤维化也累及相邻的食管壁，从而导致进行性狭窄。
