Takayasu Hajime, Masumoto Kouji, Ishikawa Miki, Sasaki Takato, Ono Kentaro
Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
Surg Case Rep. 2016 Dec;2(1):88. doi: 10.1186/s40792-016-0213-y. Epub 2016 Sep 2.
Recurrent tracheoesophageal fistula (TEF) is still difficult to diagnose and repair. In almost all cases, recurrence appears relatively soon after the primary surgery. We herein describe a case of recurrent TEF that appeared 10 years after the primary repair. At 2 years of age, the patient suffered from mental retardation due to encephalitis and developed a hiatus hernia with gastro-esophageal reflux. He underwent the repair of a hiatus hernia and fundoplication at 3 years of age. However, the hiatus hernia recurred 6 months after the operation. The patient suffered from recurrent pneumonia for 6 years after the appearance of the recurrent hiatus hernia. At 9 years of age, he was hospitalized frequently due to recurrent severe pneumonia. After admission at 9 years of age, an endoscopic study under general anesthesia was performed and revealed subglottic stenosis and a dilated esophagus with a recurrent hiatus hernia. Tracheotomy or laryngotracheal separation was first planned in order to improve his upper airway and facilitate the safer repair of the recurrent hiatus hernia. After laryngotracheal separation, the patient still suffered from severe pneumonia. In addition, a small volume of nutritional supplement was aspirated from the tracheostomy. Thus, recurrent TEF was suspected. Tests using dye under both esophagoscopy and bronchoscopy confirmed recurrent TEF. The fistula recurred in the cervical area because of the elevation of the esophagus due to the recurrent hiatus hernia. The fistula was surgically closed, with a sternothyroid muscle flap to prevent re-recurrence. At 4 months after this operation, the recurrent hiatus hernia was repaired. Thereafter, the patient's respiratory symptoms showed a dramatic improvement. The patient is now doing well and free from further recurrences of TEF and hiatus hernia at 2 years after the final operation.
复发性气管食管瘘（TEF）的诊断和修复仍然困难。几乎在所有病例中，复发都出现在初次手术后相对较短的时间内。我们在此描述一例初次修复术后10年出现的复发性TEF病例。患者2岁时因脑炎导致智力发育迟缓，并出现伴有胃食管反流的食管裂孔疝。他在3岁时接受了食管裂孔疝修补术和胃底折叠术。然而，术后6个月食管裂孔疝复发。复发性食管裂孔疝出现后，患者反复发生肺炎6年。9岁时，他因反复严重肺炎频繁住院。9岁入院后，在全身麻醉下进行了内镜检查，发现声门下狭窄和扩张的食管伴有复发性食管裂孔疝。最初计划进行气管切开术或喉气管分离术，以改善其上呼吸道并便于更安全地修复复发性食管裂孔疝。喉气管分离术后，患者仍患有严重肺炎。此外，从气管造口吸出少量营养补充剂。因此，怀疑有复发性TEF。在食管镜检查和支气管镜检查下使用染料进行的测试证实了复发性TEF。由于复发性食管裂孔疝导致食管抬高，瘘管在颈部区域复发。通过胸骨甲状肌瓣手术关闭瘘管，以防止再次复发。此次手术后4个月，修复了复发性食管裂孔疝。此后，患者的呼吸道症状有了显著改善。在最后一次手术后2年，患者目前情况良好，未再出现TEF和食管裂孔疝的复发。
