Bondonny J M, Hehunstre J P, Diard F, Bechraoui T
Chir Pediatr. 1979;20(2):69-73.
Dysphagia of the newborn and the infant presents with many varied causes, neurological, malformative, turmoral or functional. Among the latter, cricopharyngeal achalasia is an exceptional entity open to discussion. Suspected as early as the first month, presenting with difficulty in swallowing with choking episodes and coughing up of food without any obvious etiology. Profile roetgengraphic studies will allow the diagnosis to be made. The characteristic sign is a round and regular posterior narrowing on the posterior wall of the esophagus (C4 - C5 level) with enlargement of the hypopharynx. This narrowing is a constant finding. This pathological entity, an absence of relaxation of the cricopharyngeus muscle during the third period of swallowing, well-known in the adult patient, has only exceptionally been described among newborn children. In the following case study, cure has only been obtained by an extra mucosal myotomy of the esophagus at the age of seven months. The discussion, considering the five cases reported in pediatric journals, covers the diagnostic elements, the physiopathology of the disease, the risks presented during evolution without treatment. Therapy must be precocious and surgical.
新生儿和婴儿吞咽困难有多种原因,包括神经、畸形、肿瘤或功能性原因。在后者中,环咽失弛缓症是一个值得探讨的特殊情况。早在第一个月就可怀疑,表现为吞咽困难并伴有呛咳发作以及无明显病因的食物咳出。食管造影研究有助于做出诊断。特征性征象是食管后壁(C4 - C5水平)有一个圆形且规则的后部狭窄,同时下咽扩大。这种狭窄是一个恒定的表现。这种病理情况,即在吞咽第三期环咽肌缺乏松弛,在成年患者中很常见,但在新生儿中仅有个别报道。在以下病例研究中,仅在七个月大时通过食管黏膜外肌切开术才得以治愈。结合儿科期刊报道的五例病例进行讨论,涵盖了诊断要素、疾病的生理病理学、未经治疗病情发展过程中出现的风险。治疗必须尽早且采用手术方式。