Coexisting left congenital diaphragmatic hernia and esophageal atresia with tracheoesophageal fistula: successful management in a premature neonate.
The combination of left congenital diaphragmatic hernia (CDH) with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The authors describe a premature neonate with this association, who is alive at 6 1/2 years of age. Temporary banding of the gastroesophageal junction and gastrostomy was performed concurrently with hernia repair and prosthetic abdominoplasty to enlarge the abdominal cavity. A right thoracotomy for ligation of the fistula, using extracorporeal membrane oxygenation (ECMO), was performed 13 days later. Complete repair of the esophageal atresia was accomplished 7 weeks after birth. The methods that have been suggested in the literature are discussed. The institution of ECMO at birth could allow a primary complete surgical repair of EA and CDH. Nevertheless, surgical management with staged repair, as described herein, can be useful.
Sapin
E
E
Department of Pediatric Surgery, Hopital Saint Vincent de Paul, CHU Cochin-Port-Royal, Université Rene Descartes, Paris, France.
Berg
A
A
Raynaud
P
P
Lapeyre
G
G
Seringe
R
R
Helardot
P G
PG
D000005:Abdomen / Q000601:surgery; D004933:Esophageal Atresia / Q000150:complications* / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D005774:Gastrostomy; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D008297:Male; D019736:Prostheses and Implants; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000151:congenital* / Q000601:surgery