A Trisomy 18 Patient who Underwent Repair for Esophageal Atresia and Removal of Lower Esophageal Banding

Abstract

A girl who had been diagnosed as having trisomy 18 at 30 weeks of gestation was born at 32 weeks of gestational age with a body weight of 1,013 g. According to the prenatal explanation and discussion, she was intended to receive standard care treatment only. However, the parents wished mechanical ventilation for her dyspnea, and the treatment strategy gradually became aggressive. At six days of age, she underwent gastrostomy and lower esophageal banding for type C esophageal atresia. Her cardiac disease was patent ductus arteriosus only, which was ligated at 1 month of age. Tracheotomy was performed at 6 months of age, and she was discharged to home at 10 months of age. Thereafter, because saliva aspiration from the upper esophagus became difficult, repair for esophageal atresia and removal of lower esophageal banding were performed at the age of 1 year and 10 months. Although anastomotic stenosis requiring dilation developed postoperatively, she acquired some ability for oral intake and showed gradual and slight growth and development. When determining the medical care of newborns with severe disease, healthcare providers and patients’ families must fully discuss all options. We encountered difficulties in determining the repair for esophageal atresia after lower esophageal banding in the current patient because it was an almost unprecedented treatment. The experience of managing this patient has provided many lessons for us.