Department of Surgery, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal.
Laligurans Hospital, Talchhikhel-14, Lalitpur, Nepal.
JNMA J Nepal Med Assoc. 2020 Dec 31;58(232):1075-1079. doi: 10.31729/jnma.5207.
Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on the 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with a rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.
食管气管瘘是一种具有挑战性的异常,发病率罕见,主要表现为呼吸系统症状,有时也会出现消化系统症状。我们报告了一例罕见的女性患儿食管闭锁伴远端食管气管瘘,其母亲在剖宫产前行超声检查时发现严重羊水过少和宫内生长受限。早产儿和极低出生体重儿出生后,我们最初诊断为呼吸窘迫综合征合并马蹄内翻足。然而,在第 2 天,由于鼻胃管插入超过 10cm 仍未成功,且 X 线检查显示有橡胶导管,我们诊断为食管闭锁伴远端食管气管瘘。我们成功地进行了右侧开胸术,结扎瘘管,并进行端端吻合,没有出现并发症。患儿开始增重后,即开始进行母乳喂养,并在出院。术后 2 周时出现早期并发症(吻合口狭窄),但通过内镜球囊扩张得到纠正。目前,该患儿 18 个月大,体重 10 公斤,健康状况良好。