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Rare Case of Cervical Esophageal Atresia with Tracheo Esophageal Fistula How To Diagnose and How To Manage
Alexandra Sachlan
Harapan Kita Woman and Children Hospital Jakarta Indonesia
Introduction
Type C is most common type of Esophageal Atresia (EA) with Tracheo Esophageal Fistula (TEF) according to Gross Clasification of EA. Repair of EA is usually performed by thoracic approach in type C. Case of EA type C located in high posistion (Cervical) is a rare case , however, the alternative apporach is cervical. This Case is reporting EA with high level of TEF and using Cervical aproach
Case Presentation
A term female neonate was delivered to a healthy 28-year-old primigravida with no history of substance use or pregnancy-related complications. The neonate presented with hypersalivation, and an orogastric tube could not be advanced into the stomach, suggesting possible esophageal obstruction. Radiologic examination showed that tube stop at first Thoracal vertebra with presence gas in the abdomen . We diagnosed as EA with TEF. Esophagography demonstrated a blind-ending proximal esophageal pouch, with contrast entering the trachea and passing through a distal tracheoesophageal fistula, thereby opacifying the distal esophagus. The location of fistula was close to proximal pouch esophagus. Preoperative bronchoscopy was performed to identify the tracheoesophageal fistula, which was subsequently marked at the cervical level. Given the clear location of the fistula, a cervical surgical approach was chosen. A transverse incision was made in the left cervical supraclavicular region, and the sternocleidomastoid muscle along with the carotid sheath was retracted posterolaterally. We successfully identified proximal Esofagus and TEF. The fistula was divided, the tracheal defect was closed, and an end-to-end esophageal anastomosis was performed.
Conclusion
We should be aware the presence of EA with cervical TEF. The reliable methods for detecting the location of the distal TEF are preoperative bronchoscopy and contrast study. Transcervical repair is a feasible and effective approach for case like this.