Abstract
In the present report, we describe a case of Gross type D esophageal atresia (EA) that was diagnosed preoperatively. The patient was a male infant delivered at 41 weeks and 5 days, with a birth weight of 3,836 g. He was suspected of having EA on the basis of findings of drooling, cyanosis, and meconium staining. In addition, the medical staff encountered difficulty in inserting a nasogastric tube. However, chest radiography did not indicate coiling of the nasogastric tube, and thus esophagography was performed. Esophagography indicated the upper esophageal pouch, trachea, and lower esophagus. On the basis of these findings, he was diagnosed as having Gross type D EA. He was then transferred to our hospital and underwent primary anastomosis and fistula ligation on the same day. After the operation, a proximal tracheo-esophageal fistula (TEF) scar resulted in the development of tracheomalacia and tracheal collapse. Therefore, we performed tracheostomy 28 days after the surgery for fistula ligation. The infant’s respiratory condition became stable after the tracheostomy. He was weaned from mechanical ventilation and transferred to the pediatrics unit 30 and 42 days after the fistula ligation, respectively. Although the preoperative diagnosis of Gross type D EA is difficult, severe respiratory complications may develop if proximal TEF is overlooked. Hence, proximal TEF should be considered in all cases of EA. We consider that preoperative bronchoscopy is the most appropriate method for diagnosing proximal TEF.
