Gross B 型食道閉鎖症診断治療上の問題点

抄録

In type B esophageal atresia, presence of proximal pouch fistula is sometimes difficult to to diagnose in the earliest stage of life. Wide gap between upper and lower segment presents the main therapeutic problem. This paper describes successful treatment of a case by delayed primary anastomosis after bougienage of the upper and lower pouch and closure of tracheoesophageal fistula. A male newborn with a birth weight of 2,335 g was diagnosed to have esophageal atresia. Proximal fistula was not diagnosed by Dionosil swallow performed on admission. Following gastrostomy which was done on the second day of life, proximal and distal esophageal bougienage was commenced. The patient had been well until two and a half months when there was sudden onset of cyanosis. Proximal pouch fistula was revealed at the level of the first thoracic vertebra by Dionosil swallow. The gap between proximal and distal pouch of the esophagus showed a length of six and a half vertebrae. The upper tracheoesophageal fistula was closed transcervically. The esophageal bougienage was continued untill four and a half months when both ends met together. Finally, esophageal anastimosis with circular myotomy was performed through extrapleural approach. Postoperative course was uneventful.