SRC Paediatric Allergology and Gastroenterology, Department of Paediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University Torun, Torun Poland.
Department of Paediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University Torun, Torun Poland.
J Mother Child. 2021 Jul 16;24(4):34-39. doi: 10.34763/jmotherandchild.20202404.d-20-00013.
Pathological gastro-oesophageal reflux (GER) is one of the most common complications that results in the aftermath of treatment of congenital oesophageal atresia (EA). The aim of this study is to present a case of a 7-year-old girl with severe gastro-oesophageal reflux disease (GERD) operated on in the neonatal period due to EA with a lower tracheo-oesophageal fistula (TEF). The patient, despite the use of adequate conservative treatment, clinically and in the endoscopic examination was diagnosed with severe oesophagitis (LA-D in the Los Angeles classification). After a laparoscopic fundoplication by the Nissen method at the age of 4, a transient clinical improvement and a reduction of inflammatory lesions in the oesophagus were obtained. Three years after the procedure, the patient presented with deterioration of GERD clinical symptoms in the form of: regularly occurring vomiting with periodic admixture of fresh blood, recurrent cough, symptoms of dysphagia and failure to thrive. An upper gastrointestinal endoscopy (upper GI endoscopy) revealed significant progression of inflammatory changes in the oesophagus and the two-level oesophageal stricture together with endoscopic signs of wrap disruption. Based on the conducted diagnostics, the girl was qualified for surgical revision. The diagnosis was confirmed intraoperatively. During the 4-month postoperative period, a significant clinical improvement and resolution of symptoms were observed. The presented case indicates the need for close and long-term monitoring of patients after EA. In the case of a recurrent reflux oesophagitis in patients after anti-reflux surgery, the possibility of prolonged complications, such as a wrap disruption, herniation or slippage should be taken into consideration.
病理性胃食管反流（GER）是先天性食管闭锁（EA）治疗后最常见的并发症之一。本研究旨在介绍一例 7 岁女孩，她在新生儿期因 EA 合并低位气管食管瘘（TEF）而接受手术治疗，患有严重的胃食管反流病（GERD）。尽管患者接受了充分的保守治疗，但在临床和内镜检查中，她被诊断为严重食管炎（洛杉矶分类中的 LA-D）。在 4 岁时，通过腹腔镜行 Nissen 胃底折叠术，患者获得了短暂的临床改善和食管炎症病变的减少。然而，在手术后 3 年，患者出现 GERD 临床症状恶化，表现为：经常发生呕吐，伴有新鲜血液混合，反复咳嗽，吞咽困难和生长不良。上消化道内镜（上消化道内镜）显示食管炎症改变显著进展，以及二级食管狭窄，伴有包裹破裂的内镜迹象。基于进行的诊断，该女孩有资格接受手术修正。术中确诊。在 4 个月的术后期间，观察到显著的临床改善和症状缓解。所介绍的病例表明，需要对 EA 后患者进行密切和长期监测。对于抗反流手术后出现复发性反流性食管炎的患者，应考虑包裹破裂、疝出或滑脱等长期并发症的可能性。
