Cervical Esophageal Atresia By Ralph 1. Swank,
II, and George A. Harkins
A
WHITE MALE was born at term to a healthy 27-yr-old gravida I with no history of drug use or complications of pregnancy. He was noted at birth to have bilateral dislocated hips, a weak hoarse cry, and absent thumbs. Roentgenograms also showed an absent neural arch in the fourth cervical vertebra and malformed ribs. A tube could not be passed into his stomach; a contrast study showed atresia of esophagus at the level of the suprasternal notch and a proximal fistula (Fig. 1A). The contrast entered the trachea and was expelled through the distal fistula, showing the lower esophagus. Since both ends were so high, it was decided to repair the defect through the neck. A gastrostomy was done, and the neck was explored through a left cervical incision, dividing the sternocleidomastoid muscle. The lower fistula was of the type usually seen at the carina, while the proximal one was just a window. The fistulas were taken down, closing the tracheal defects, and an end-to-end anastomosis of one esophagus was done in two layers (Fig. 1B).
Fig. 1. (A) Roentgenogmm shows atresia of esophagus and fistula. (8) Diagram of anatomic point at operation.
proximal
tracheoesophageal
From Tampa General Hospital, Tampa, Fla., and Children’s Hospital of the King’s Daughters, Norfolk, Va. Presented before the 6th Annual Meeting of the American Pediatric Surgical Association, San Juan. Puerto Rico, April 10-12. 1975. Addressfor reprint requests: Ralph L. Swank II, M.D.. Tampa General Hospital. Tampa, Fla. 33603.
Q 1975 by Grune & Stratton, Inc. Journal of Pediatric Surgery, Vol. 10, No. 5 (October), 1975
795
796
SWANK
AND HARKINS
He recovered reasonably well but had one episode of aspiration, followed by right upper lobe pneumonia. Two weeks postoperatively he had some choking, and barium swallow showed a stricture at the anastomosis. Also seen was an anomalous right subclavian artery. This stricture required dilatation then and on three subsequent occasions. At esophagoscopy 5 mo postoperatively, the anastomosis looked normal. At 14 yr of age, he still has difficulty with his hips after two open reductions, still has a weak, hoarse voice, and has a definite scoliosis. His weight is below the third percentile, but he has no difficulty swallowing. We were unable to find a report in the literature of the repair of an esophageal atresia through a cervical incision.
II, and George A. Harkins
A
WHITE MALE was born at term to a healthy 27-yr-old gravida I with no history of drug use or complications of pregnancy. He was noted at birth to have bilateral dislocated hips, a weak hoarse cry, and absent thumbs. Roentgenograms also showed an absent neural arch in the fourth cervical vertebra and malformed ribs. A tube could not be passed into his stomach; a contrast study showed atresia of esophagus at the level of the suprasternal notch and a proximal fistula (Fig. 1A). The contrast entered the trachea and was expelled through the distal fistula, showing the lower esophagus. Since both ends were so high, it was decided to repair the defect through the neck. A gastrostomy was done, and the neck was explored through a left cervical incision, dividing the sternocleidomastoid muscle. The lower fistula was of the type usually seen at the carina, while the proximal one was just a window. The fistulas were taken down, closing the tracheal defects, and an end-to-end anastomosis of one esophagus was done in two layers (Fig. 1B).
Fig. 1. (A) Roentgenogmm shows atresia of esophagus and fistula. (8) Diagram of anatomic point at operation.
proximal
tracheoesophageal
From Tampa General Hospital, Tampa, Fla., and Children’s Hospital of the King’s Daughters, Norfolk, Va. Presented before the 6th Annual Meeting of the American Pediatric Surgical Association, San Juan. Puerto Rico, April 10-12. 1975. Addressfor reprint requests: Ralph L. Swank II, M.D.. Tampa General Hospital. Tampa, Fla. 33603.
Q 1975 by Grune & Stratton, Inc. Journal of Pediatric Surgery, Vol. 10, No. 5 (October), 1975
795
796
SWANK
AND HARKINS
He recovered reasonably well but had one episode of aspiration, followed by right upper lobe pneumonia. Two weeks postoperatively he had some choking, and barium swallow showed a stricture at the anastomosis. Also seen was an anomalous right subclavian artery. This stricture required dilatation then and on three subsequent occasions. At esophagoscopy 5 mo postoperatively, the anastomosis looked normal. At 14 yr of age, he still has difficulty with his hips after two open reductions, still has a weak, hoarse voice, and has a definite scoliosis. His weight is below the third percentile, but he has no difficulty swallowing. We were unable to find a report in the literature of the repair of an esophageal atresia through a cervical incision.
