title: Delayed primary reconstruction of esophageal atresia and distal tracheoesophageal fistula in a 471-g infant.
abstract: BACKGROUND
  Waterston et al. have classified the risk of morbidity in infants with esophageal atresia and tracheoesophageal fistula. However, few cases of esophageal atresia with distal tracheoesophageal fistula in extremely low birth weights infants have been reported. In such infants, the selection of primary reconstruction or staged repair remains controversial. In the present report, we describe the difficulties of perioperative management of such small infants and discuss how to rescue them.
  
  
  METHODS
  A 471-g female infant was delivered at 28 weeks' gestation via cesarean section. Esophageal atresia with distal tracheoesophageal fistula was diagnosed. Esophageal banding and gastrostomy were performed via laparotomy on day 1. On day 74, when the infant weighed almost 1000g, airway management was discontinued. On day 136, endotracheal intubation again became necessary because of respiratory problems, and the esophagus was reconstructed on day 141. Despite this operation, the patient died on day 276 because of continuing respiratory problems.
  
  
  CONCLUSIONS
  Esophageal banding is considered an appropriate treatment for respiratory problems in such extremely low weight infants. However, the timing of dissection of the tracheoesophageal fistula after esophageal banding is extremely important.
  
  
  CONCLUSIONS
  In the present case, ligation of the tracheoesophageal fistula and esophageal reconstruction should have been performed as soon as possible.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: keke-ito@jikei.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ashizuka
authors.forename: Masashi
authors.initials: M
authors.lastname: Kurobe
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Ohashi
authors.forename: Naruo
authors.initials: N
authors.lastname: Kuwashima
authors.forename: Joji
authors.initials: J
authors.lastname: Yoshizawa
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki