- Email: [email protected]
Laryngo-tracheo-esophageal fissure: Report of four cases
ABSTRACTS
493
cardiac catheterization confirmed a left atrial myxoma that prolapsed into the ventricle in diastole. The tumor was removed and the patient's neurologic and cardiovascular symptoms have completely resolved. Atrial myxomas present with constitutional symptoms, obstruction to flow, and embolization. Seventy-five percent arise in the left atrium. This patient's prolonged constitutional symptoms before obstructive or embolic events occurred is unusual.--Randall W. Powell ALIMENTARY TRACT Laryngo-Tracheo-Esophageal Fissure: Report of Four Cases P. Dodero, M. Martinelli, A. E. Pallecchi, et al. Rass
Ital Chir Ped 19:255, 1977. Four cases of laryngo-tracheo-esophageal fissure are reported. One case was associated with esophageal atresia and lower tracheo-esophageal fistula. Respiratory difficulty and choking occurred during feedings after successful primary repair. A mild laryngeal fissure was discovered but the difficulty in swallowing disappeared spontaneously. At the age of 3 yr the slight cleft was still present but symptomless. A second case unassociated with other tracheo-esophageal abnormalities presented with a severe cleft involving the larynx and the proximal trachea. Hypertelorism and hypospadia were also present. Resuscitation failed and autopsy revealed a very extensive tracheoesophageal cleft and a hypoplastic epiglottis. The third case, associated with esophageal atresia and lower tracheoesophageal fistula, was operated on successfully but on the seventh postoperative day presented dyspnea, cyanosis, and cough. Laryngoscopy disclosed a small posterior laryngeal fissure. The symptoms disappeared spontaneously. The fourth case presented soon after birth with dyspnea, cyanosis, and severe respiratory distress; associated anomalies were hypospadias, bilateral cryptorchidism, and hypertelorism. The abdomen was distended by gas and attempts at feeding were followed by cyanosis and choking. The esophagogram showed a very extensive communication between the esophagus and the trachea at the level of C4-C5. Laryngoscopy showed a large extensive fissure on the posterior wall of the larynx and trachea. Closure by suture of the tracheo-esophageal cleft was performed. One month after the operation the baby was well and incoordination of swallowing had disappeared. These 4 cases added to 38 described in the literature, bring the total of the reported cases to 42. Treatment may be conservative in mild cases but surgical repair of the cleft is indicated in more severe cases.--C. A. Montagnani Associated Malformations in Congenital Esophageal Stenosis Due to Trachao-Bronchial Remnants. T. Nishina, Y.
Tsuchida, and S. Saito. J Jpn Soc Pediatr Surg 14:10091016, (December), 1978.
The authors collected 80 patients with congenital esophageal stenosis due to tracheo-bronchial remnants in Japan both from the literature and questionaire. Association of other congenital malformations was found in 14 (17.5%) of these 80 cases; congenital esophageal atresia with tracheoesophageal fistula in 3, tracheo-esophageal fistula in 1, ano-vestibular fistula in 3, Meckel's diverticulum in 1,
tetralogy of Fallot and Down's syndrome in 1, ventricular septal defect in 1, microphthalmus in 1, haemangioma in 1, and Down's syndrome in 2 patients. As the incidence of associated malformations in congenital esophageal atresia in Japan was reported as 143 (34.4%) in 416 patients, the incidence of associated malformations is about twice as high in congenital esophageal atresia as in congenital esophageal stenosis.--H. Suzuki Surgical Management of Tracheoesophageal Fistula Complicating Caustic Ingestion. J. D. Burringlon and J. G.
Raffensperger. Surgery 84:329, (September), 1978.
Extensive corrosive esophageal burns in children may be complicated by the development of a tracheoesophageal fistula. Detailed reports of the management of six children with this problem indicates that direct closure of the fistula by suturing is unsuccessful. The authors suggest a five-point plan of management as follows (1) Early radiological identification of TEF with thin barium or Dionosil; (2) Early tracheostomy; (3) End cervical esophagostomy with closure of distal esophageal stump; (4) Gastrostomy; (5) Complete division of distal esophagus. This initial treatment can be done as a single operation and esophageal replacement by colon or gastric tube done 6 to 12 mo later. Four of the six children treated in this fashion are able to eat normally.William K. Sieber Esophageal Atresia and Tracheoesophageal Fistula: Effect of Delayed Thoracotomy on Survival. J. L. Grosfeld and
T. K. N. Ballantine. Surgery 84:394 402, (September), 1978.
This review of the management of 84 infants with esophageal atresia and/or tracheoesophageal fistula records the experience from 1972 to 1977 at the James Whitcomb Riley Hospital in Indianapolis, Indiana. The authors stress the importance of prompt gastrostomy, often under local anesthesia, and the delay of a thoracotomy for definitive surgical corrections until stabilization or improvement of any respiratory and/or medical problems. Delayed thoracotomy rather than staging is recommended--the delay averaging 3.9 days. Seventy-nine of the eighty-four patients had a surgical procedure and of these 4, or 5%, died immediately postoperatively. Fifty-five patients had a primary anastomosis only. The telescoping two-layer Haight type of anastomosis was associated with the lowest number of leaks but did require prophylactic dilatation to avoid stricture. Anastomotic leaks occurred in 10 of the 55 primary anastomoses. There were 8 late deaths (4 to 39 mo postoperatively). The overall mortality was 15%. The authors note that neonatal intensive care has increased the survival rate of these patients and they urge prompt gastrostomy with delayed rather than immediate emergency thoracotomy in the management of these infants.--William K. Sieber An Assessment of Gastroesophageal Reflux in Children by Extended pH Monitoring of the Distal Esophagus. S. G.
Jolley, D. G. Johnson, J. J. Herbst, et al. Surgery 84:16, (July), 1978.
Continuous monitoring of the distal esophagus in 38 children under 12 yr of age for a period of 18-24 hr provided
493
cardiac catheterization confirmed a left atrial myxoma that prolapsed into the ventricle in diastole. The tumor was removed and the patient's neurologic and cardiovascular symptoms have completely resolved. Atrial myxomas present with constitutional symptoms, obstruction to flow, and embolization. Seventy-five percent arise in the left atrium. This patient's prolonged constitutional symptoms before obstructive or embolic events occurred is unusual.--Randall W. Powell ALIMENTARY TRACT Laryngo-Tracheo-Esophageal Fissure: Report of Four Cases P. Dodero, M. Martinelli, A. E. Pallecchi, et al. Rass
Ital Chir Ped 19:255, 1977. Four cases of laryngo-tracheo-esophageal fissure are reported. One case was associated with esophageal atresia and lower tracheo-esophageal fistula. Respiratory difficulty and choking occurred during feedings after successful primary repair. A mild laryngeal fissure was discovered but the difficulty in swallowing disappeared spontaneously. At the age of 3 yr the slight cleft was still present but symptomless. A second case unassociated with other tracheo-esophageal abnormalities presented with a severe cleft involving the larynx and the proximal trachea. Hypertelorism and hypospadia were also present. Resuscitation failed and autopsy revealed a very extensive tracheoesophageal cleft and a hypoplastic epiglottis. The third case, associated with esophageal atresia and lower tracheoesophageal fistula, was operated on successfully but on the seventh postoperative day presented dyspnea, cyanosis, and cough. Laryngoscopy disclosed a small posterior laryngeal fissure. The symptoms disappeared spontaneously. The fourth case presented soon after birth with dyspnea, cyanosis, and severe respiratory distress; associated anomalies were hypospadias, bilateral cryptorchidism, and hypertelorism. The abdomen was distended by gas and attempts at feeding were followed by cyanosis and choking. The esophagogram showed a very extensive communication between the esophagus and the trachea at the level of C4-C5. Laryngoscopy showed a large extensive fissure on the posterior wall of the larynx and trachea. Closure by suture of the tracheo-esophageal cleft was performed. One month after the operation the baby was well and incoordination of swallowing had disappeared. These 4 cases added to 38 described in the literature, bring the total of the reported cases to 42. Treatment may be conservative in mild cases but surgical repair of the cleft is indicated in more severe cases.--C. A. Montagnani Associated Malformations in Congenital Esophageal Stenosis Due to Trachao-Bronchial Remnants. T. Nishina, Y.
Tsuchida, and S. Saito. J Jpn Soc Pediatr Surg 14:10091016, (December), 1978.
The authors collected 80 patients with congenital esophageal stenosis due to tracheo-bronchial remnants in Japan both from the literature and questionaire. Association of other congenital malformations was found in 14 (17.5%) of these 80 cases; congenital esophageal atresia with tracheoesophageal fistula in 3, tracheo-esophageal fistula in 1, ano-vestibular fistula in 3, Meckel's diverticulum in 1,
tetralogy of Fallot and Down's syndrome in 1, ventricular septal defect in 1, microphthalmus in 1, haemangioma in 1, and Down's syndrome in 2 patients. As the incidence of associated malformations in congenital esophageal atresia in Japan was reported as 143 (34.4%) in 416 patients, the incidence of associated malformations is about twice as high in congenital esophageal atresia as in congenital esophageal stenosis.--H. Suzuki Surgical Management of Tracheoesophageal Fistula Complicating Caustic Ingestion. J. D. Burringlon and J. G.
Raffensperger. Surgery 84:329, (September), 1978.
Extensive corrosive esophageal burns in children may be complicated by the development of a tracheoesophageal fistula. Detailed reports of the management of six children with this problem indicates that direct closure of the fistula by suturing is unsuccessful. The authors suggest a five-point plan of management as follows (1) Early radiological identification of TEF with thin barium or Dionosil; (2) Early tracheostomy; (3) End cervical esophagostomy with closure of distal esophageal stump; (4) Gastrostomy; (5) Complete division of distal esophagus. This initial treatment can be done as a single operation and esophageal replacement by colon or gastric tube done 6 to 12 mo later. Four of the six children treated in this fashion are able to eat normally.William K. Sieber Esophageal Atresia and Tracheoesophageal Fistula: Effect of Delayed Thoracotomy on Survival. J. L. Grosfeld and
T. K. N. Ballantine. Surgery 84:394 402, (September), 1978.
This review of the management of 84 infants with esophageal atresia and/or tracheoesophageal fistula records the experience from 1972 to 1977 at the James Whitcomb Riley Hospital in Indianapolis, Indiana. The authors stress the importance of prompt gastrostomy, often under local anesthesia, and the delay of a thoracotomy for definitive surgical corrections until stabilization or improvement of any respiratory and/or medical problems. Delayed thoracotomy rather than staging is recommended--the delay averaging 3.9 days. Seventy-nine of the eighty-four patients had a surgical procedure and of these 4, or 5%, died immediately postoperatively. Fifty-five patients had a primary anastomosis only. The telescoping two-layer Haight type of anastomosis was associated with the lowest number of leaks but did require prophylactic dilatation to avoid stricture. Anastomotic leaks occurred in 10 of the 55 primary anastomoses. There were 8 late deaths (4 to 39 mo postoperatively). The overall mortality was 15%. The authors note that neonatal intensive care has increased the survival rate of these patients and they urge prompt gastrostomy with delayed rather than immediate emergency thoracotomy in the management of these infants.--William K. Sieber An Assessment of Gastroesophageal Reflux in Children by Extended pH Monitoring of the Distal Esophagus. S. G.
Jolley, D. G. Johnson, J. J. Herbst, et al. Surgery 84:16, (July), 1978.
Continuous monitoring of the distal esophagus in 38 children under 12 yr of age for a period of 18-24 hr provided