Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Esophageal Reconstruction with Gastric Pull-up in a Premature Infant with Type B Esophageal Atresia

  • Han, Young Mi (Division of Neonatology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Lee, Narae (Division of Neonatology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Byun, Shin Yun (Division of Neonatology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine) ;
  • Kim, Soo-Hong (Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Cho, Yong-Hoon (Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Kim, Hae-Young (Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine)
  • Received : 2018.07.14
  • Accepted : 2018.09.08
  • Published : 2018.11.30
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Abstract

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.

Keywords

References

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