WOFAPS 2025 8th World Congress of Pediatric Surgery

Girts Aleksejevs, Kristina Karganova, Viktorija Arnite, Zane Abola

Childrens Clinical University Hospital

Introduction
Accessory bronchi are rare congenital anomalies of the tracheobronchial tree, often presenting with subtle, recurrent respiratory symptoms. Their infrequent occurrence and nonspecific manifestations frequently delay diagnosis.

Case Presentation
A 5-year-old girl presented with intermittent coughing from infancy, recurring every 2–3 weeks and unresponsive to medical therapy. Initial workup was inconclusive. Bronchoscopy suggested a possible broncho-esophageal fistula, prompting a treatment plan involving laser coagulation under simultaneous bronchoscopy and gastroscopy. During the procedure, a probing maneuver of the suspected bronchus excluded fistula formation. An accessory bronchus was confirmed via prior CT imaging, and laser coagulation of its lumen was performed. The procedure was uneventful. Postoperatively, the patient had complete resolution of symptoms with no recurrence during follow-up.

Conclusion
This case illustrates the importance of considering congenital bronchial anomalies in persistent pediatric respiratory complaints. It also highlights the diagnostic challenges when such anomalies mimic other conditions, like bronchoesophageal fistula. Combined use of flexible endoscopy and imaging allowed for accurate diagnosis and effective treatment via endoscopic laser coagulation. Such intervention led to excellent clinical outcome with minimal invasiveness.