A Case of Gross A Long-Gap Esophageal Atresia Successfully Treated by Esophageal Lengthening Using External Traction; Modified Foker Technique

Abstract

A baby girl born at 37 weeks weighing 1,826g had Gross A long-gap esophageal atresia (3 vertebrae gap). At 33 weeks, the prenatal sonogram detected the presence of polyhydramnios together with an absent fetal stomach bubble. The MRI showed a dilatation of the blind-ending esophagus. A chest and abdominal x-ray showed the orogastric tube coiled in the upper esophagus and a gasless bowel. Gastrostomy and gradual stretching with pressure bougienage (Howard technique) were carried out. On day 31, lower esophageal end was perforated through pressure bougienage, therefore external traction (modified Foker technique) was applied. Daily traction on both esophageal ends was started on day 4 postoperatively. On day 49 an esophageal anastomosis was achieved with minimal tension. Six months later she is doing well tolerating full oral feedings and gaining weight. External traction using modified Foker technique induced elongation in the esophageal segments within days and allowed a primary repair of the long-gap.