1982 年 18 巻 4 号 p. 829-835
Two cases of gasless Gross type C esophageal atresia were presented. Both were diagnosed of esophageal atresia without tracheoesophageal fistula (TEF) since no gas could be found in the gastrointestinal tract. Case 1. A 3 day old male neonate developed excessive salivation and cyanotic spell shortly after birth. Roentgen studies showed coil-up sign and airless abdomen. On the basis of this study, the preoperative diagnosis was esophageal atresia without tracheoesophageal fistula. Gastrostomy was performed at the age of four days. The stomach was relatively small. Two days after operation, feeding via gastrostomy was started. The patient did very well. Any complication such as pneumonia was not noted. At twenty-eighth day of age, a metal prove was inserted into the distal esophagus through gastrostomy for the purpose of measuring the gap between the upper and lower esophagi. The prove was found in the trachea. Immediately the ligation of TEF and esophage-esophagostomy was performed by extrapleural approach. The location of TEF was slightly cephalad of bifurcation. Stenosis or plugging in the TEF was not found. Postoperative course was uneventful. Case 2. A female neonate was born after pregnancy complicated by hydramnios. Routine nasogastric tubing had found esophageal atresia. Roentgen studies five hours after birth revealed airless abdomen. On the next day, gastrostomy was performed. The stomach was relatively small. When gastrostomy feeding was initiated, she became cyanotic and vomited saliva with coughing. On the eighth day of birth, TEF ligation was performed. Postoperative course was complicated with respiratory distress. She died of pneumonia with mediastinitis on the twelveth postoperative day. In our survey of Japanese cases, the incidence of such type TEF cases was only 5.6% (6 of 108 Cases). For the accurate diagnosis of this condition, the lower esophageal pouch should be examined by air or contrast media through gastrostomy before gastrostomy feeding is initiated.