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Oesophageal atresia with proximal tracheo-oesophageal fistula
INTERNATIONAL ABSTRACTS
an index on ventilation (VI = mean airway pressure X respiratory rate) and confirmed by postmortem analysis of the lung. Those infants were PaCOz >40 mmHg before surgery had a 77% mortality. When P a C e 2 reduction could be achieved only with VI > 1,000, the mortality was still >50%. After repair, however, the ability to hyperventilate to P a C e 2 <40 mmHg proved to be an important determinant of survival. Only one of 31 infants in this group died, whereas only two of 27 infants with PaCe2 >40 mmHg survived. In 16 infants with P a C e 2 >40 mmHg despite hyperventilation, highfrequency oscillatory ventilation was started. This resulted in a rapid fall in PaCe2, but 14 of the 16 infants had only temporary improvement in oxygenation and died. In five of the infants who died, alveolar number was assessed by postmortem morphometric analysis. There was a severe reduction to < 10% of published normal neonatal values. Pulmonary vascular changes of increased muscularization were less remarkable than those observed in infants with persistent pulmonary hypertension. These findings suggest that the degree of pulmonary hypoplasia (which would not be influenced by surgical repair), rather than the pulmonary vascular abnormality, mainly determines survival. Consideration might, therefore, be given to an initial nonsurgical approach to congenital diaphragmatic hernia with the expectation that pulmonary function might improve and pulmonary vascular resistance decrease.--George Holcornb, j r
493
evaluated the role of the chest radiograph, high kV films, CT, and bronchoscopy in five patients with congenital tracheal stenosis. CT was superior to chest radiography and high kV films in the evaluation of the presence and extent of the stenosis. CT was superior to bronchoscopy in the evaluation of the distal extent of the stenosis in two patients. In addition, CT is useful in ruling out external compression of the trachea by a mass or associated vascular anomaly. Prem Puri latrogenic Causes of Large Pleural Fluid Collections in the Premature Infant: Ultrasonic and Radiographic Findings. J. Amodio, S.
Abramson, I,IL. Berdon, et al. Pediatr Radiol 17:104-108, (February), 1987. Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct erosion by the inferior vena caval TPN catheter into the pleural space. Ultrasonography was most helpful in detecting these pleura/ collections. It is important to recognize the presence of pleural fluid in these infants as a marker of iatrogenic injury.--Prem Puri
Effects of Surgical Repair on Respiratory Mechanics in Congenital Diaphragmatic Hernia. H. Sakai, M. Tamura, Y. Hosokawa, et al. J
Pediatr 111:432-438, (September), 1987. To determine whether surgical repair of congenital diaphragmatic hernia (CHD) results in improvement in respiratory mechanics, the respiratory system compliance was measured in nine patients (five survivors and four nonsurvivors) before and after operation. In all nine infants, CHD was diagnosed within six hours of life, and surgical repair was through an abdominal approach after a period of stabilization. Measurements were made noninvasively using the passive expiratory flow-volume technique. In only one of the nine infants did compliance immediately improve after surgical repair, and in another it showed no change. Both of these infants survived, with an uneventful postoperative course. In the remaining seven infants, however, postoperative compliance immediately decreased from 10% to 77% from the preoperative value. The four infants with more than 50% decrease in compliance died with increasing hypoxemia and acidosis, These results suggest that respiratory mechanics in CHD, far from improving, frequently deteriorate as a result of repair of the hernia. The role of urgent surgery in this malformation should be reevaluated.--George Holcomb, Jr The Spectrum of Bronchopulmonary Foregut Malformations. N.
McMullin, O. Doi, and M. Kent. Pediatr Surg Int 2:304-306, (September), 1987. Bronchogenic cysts and pulmonary sequestrations have in the past been defined as separate congenital pathologic entities. The association of both in one mediastinal lesion is very rare. Such a case is reported and lends support to the concept that bronchogenic cysts and pulmonary sequestrations belong in a spectrum of bronchopulmonary malformations due to abnormal ventral budding of the primitive foregut. Their exact position in the spectrum is probably dependent on several independent key embryologic events.--Prem Puri Congenital Tracheal Stenosis: Role of CT and High kV Films. R.J. Hernandez and G.F. Tucker. Pediatr Radiol 17:192-196, (March), 1987.
Congenital tracheal stenosis is an intrinsic narrowing of the tracheal lumen due to complete cartilaginous rings. The authors
ALIMENTARY TRACT The Embryology of Usual and Unusual Types of Esophageal Atresia. D. Kluth and R. Habenicht. Pediatr Surg lnternat 2:223-227,
(July), 1987. Despite various theories, the pathogenesis of esophageal atresia is still unclear. The investigations of recent years seem to indicate that the leading role of the "septum tracheoesophageale" in normal and abnormal development of the foregut must be questioned. In this paper, new concepts of the pathogenesis of esophageal atresia are discussed with special consideration of the "unusual" types of atresia.--Prem Puri Treatment of Type A Esophageal Atresia Without Gastrostomy.
M. Carcassonne, M. Coquet and B. Kreitmann. Chirurgie 112:743745, (December), 1986. From 1973, gastrostomy had been omitted in the treatment of type A esophageal atresia. Two series were analyzed at the French Academy of Surgery: one in 1981 and the last one in 1986, From 1981 to 1986, of 54 patients, 39 were operated on without gastrostomy. No mortality was observed. The initial and late follow-up was uncomplicated. In 11 Waterston group C patients a gastrostomy was used. Three early deaths and one later death are reported. Gastrostomy is no longer considered useful in patients in good condition. Improvement of preoperative respiratory treatment should diminish the use of gastrostomy even in group C esophageal atresia.--J.M. Guys Oesophageal Atresia With Proximal Tracheo-oesophageal Fistula.
D. Cass and A. Auldist. Pediatr Surg Internat 2:212-215, (July), 1987. Esophageal atresia with proximal tracheoesophageal fistula is an uncommon subgroup comprising 2% of infants with esophageal atresia. Of those infants with esophageal atresia presenting with a gasless abdomen on initial abdominal x-ray, 23.5% had esophageal atresia with proximal tracheoesophageal fistula, and these infants thus warrant a careful study of the upper esophagus. The fistula may be difficult to demonstrate and the early appearance of contrast material in the trachea may be misinterpreted as due to aspiration or "spillover." All cases were treated differently, but a plan of manage-
494
ment evolved whose main features were the accurate demonstration of anatomy by preoperative contrast radiology, intraoperative assessment of the distal esophagus, and where possible, primary anastomosis. The authors recommend that a gastrostomy be routinely performed at the initial operation, at which time the length of the distal esophagus is assessed by the passage of a sound. If sufficient length is present, then an immediate primary anastomosis should be performed with thoracic ligation of the fistula if exposure is adequate. If at initial assessment the length of the gap is judged to be too long, the fistula should be divided via the appropriate route, cervical or thoracic, and alimentary continuity can be effected at a later time by delayed anastomosis or esophageal replacement. The major morbidity and mortality (40%) occurred in the group with a long gap between esophageal segments.--Prem Purl Oesophageal Atresia Without Fistula--Anastomosis or Replacement? N.A. Myers, S.W. Beasley, A.W. Auldist, et al. Pediatr Surg
Internat 2:216-222, (July), 1987. At the Royal Children's Hospital, Melbourne, 553 babies with esophageal atresia and/or tracheoesophageal fistula have been admitted during the past 39 years. Thirty-six (6.5%) of these had esophageal atresia without a tracheoesophageal fistula. Definitive surgery was performed in 27 patients: the primary definitive procedure was esophageal anastomosis in 15 and esophageal replacement in 12. Aspects of diagnosis and selection of the most appropriate treatment modality are discussed, with the results of treatment presented. The authors current policy is to perform an esophageal anastomosis whenever possible, and this has been successful in seven of the last 11 patients.--Prem Puri Esophageal Stenosis with Esophageal Atresia. M.A. Thomason
and B.B. Gay. Pediatr Radiol 17:197-210, (March), 1987.
Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition, the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with eosphageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.--Prem Purl Oesophageal Atresia and Vertebral Anomalies. D.R.V. Dickens and N.A. Myers. Pediatr Surg Internat 2:278-281, (September), 1987.
Esophageal atresia and/or tracheoesophageal fistula are relatively common congenital anomalies, occurring once in 3,000 births. Associated anomalies are seen frequently, and in a series of 538 patients admitted to the Royal Children's Hospital, Melbourne, 256 had additional anomalies (47.5%). Evaluation of the spine was possible in 345 patients and in 57, structural vertebral anomalies were present (16.5%). Of the 57 with a structural abnormality of the spine, 40 had an abnormality of formation, six an abnormality of segmentation, and ten had a combined defect. In the other patient, a bipartite cervical vertebra was present. Eight patients had scoliosis without a recognizable congenital spinal abnormality. In 81 there was a congenital rib abnormality. Fifty-six of this group had a normal spine, 24 had a structural abnormality of the spine, and in one patient scoliosis was present without a structural abnormality of the spine. Comparison is made between the authors findings and the
INTERNATIONAL ABSTRACTS
findings in other reported series and comments are made on the significance of spinal and/or rib anomalies in association with esophageal atresia.--Prem Purl Coexisting Left Diaphragmatic Hernia and Esophageal Atresia. R.
Udassin, O. Zamir, O. Peleg, et al. Pediatr Surg Internat 2:301-303, (September), 1987.
Coexisting left diaphragmatic hernia (DH) and esophageal atresia, a rare phenomenon, is described in two newborns, one with tracheoesophageal fistula (TEF) and the other without. The coexistence of DH and TEF in the one resulted in uncontrolled gastrointestinal distention with severe respiratory distress. Transabdominal division of the TEF was feasible and was performed concurrently with the diaphragmatic repair. Severe hypoplastic lungs and persistent pulmonary hypertension resulted in early postoperative death in both cases.--Prem Purl Congenital Tracheo-Oesophageal Fistula. N.A. Myers and K. Egami. Pediatr Surg Internat 2:198-211, (July), 1987.
At the Royal Children's Hospital, Melbourne, 28 patients with a congenital tracheoesophageal fistula were seen during a 38-year period, representing 5.2% of all babies seen with esophageal atresia and/or tracheoesophageal fistula. Diagnostic delay occurred frequently because of failure to appreciate the significance of the clinical picture. There was variation in the level of the fistula. The basic pattern of investigation and management is now quite uniform.--Prem Purl Mechanism of the Haemostatic Effect of Ethanolamine Oleate in the Injection Sclerotherapy for Oesophageal Varices. J.H. Kang, J.
Kambayashi, M. Sakon, et al. Br J Surg 74:50-53, (January), 1987.
In 20 patients undergoing injection sclerotherapy of esopahegal varices using ethanolamine oleate, the levels of two plasma fibrinopeptides (A and B 15-42) were raised one hour after injection and returned to preinjection levels after 48 hours. This indicates activation of coagulation and fibrinolysis. Plasma fibrinogen, which is regarded as a marker of inflammation, gradually increased to a maximum three days after injection. In vitro studies indicated that ethanolamine oleate prolonged clotting time and inhibited plasma fibrinopeptide A production due to chelation of calcium by the ethanolamine, whereas oleate alone shortened clotting time. The application of ethanolamine oleate and oleate alone to decapsulized rat kidney led to an increased accumulation of 12~I-labelled fibrinogen. The authors conclude that injection of ethanolamine oleate activates the local coagulation system; this may be accelerated by an acute inflammatory process.--N.P. Madden Fluoroscopically Controlled Removal of a Blunt Esophageal Foreign Body Using a Foley Catheter in Children. A. Hadary, P. Mogle, O.
Zamir, et al. Pediatr Surg lnternat 2:247-248, (July), 1987.
The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus. It reduces the risk, time, and expense involved in endoscopic removal. Prem Purl Congenital Microgastria. N.H. Aintablian, M.S. Slim, and B.W.
Antoun. Pediatr Surg Internat 2:307-310, (September), 1987.
An 81/z-year-old boy with microgastria associated with a sliding hiatal hernia and skeletal anomalies involving the spine and right
an index on ventilation (VI = mean airway pressure X respiratory rate) and confirmed by postmortem analysis of the lung. Those infants were PaCOz >40 mmHg before surgery had a 77% mortality. When P a C e 2 reduction could be achieved only with VI > 1,000, the mortality was still >50%. After repair, however, the ability to hyperventilate to P a C e 2 <40 mmHg proved to be an important determinant of survival. Only one of 31 infants in this group died, whereas only two of 27 infants with PaCe2 >40 mmHg survived. In 16 infants with P a C e 2 >40 mmHg despite hyperventilation, highfrequency oscillatory ventilation was started. This resulted in a rapid fall in PaCe2, but 14 of the 16 infants had only temporary improvement in oxygenation and died. In five of the infants who died, alveolar number was assessed by postmortem morphometric analysis. There was a severe reduction to < 10% of published normal neonatal values. Pulmonary vascular changes of increased muscularization were less remarkable than those observed in infants with persistent pulmonary hypertension. These findings suggest that the degree of pulmonary hypoplasia (which would not be influenced by surgical repair), rather than the pulmonary vascular abnormality, mainly determines survival. Consideration might, therefore, be given to an initial nonsurgical approach to congenital diaphragmatic hernia with the expectation that pulmonary function might improve and pulmonary vascular resistance decrease.--George Holcornb, j r
493
evaluated the role of the chest radiograph, high kV films, CT, and bronchoscopy in five patients with congenital tracheal stenosis. CT was superior to chest radiography and high kV films in the evaluation of the presence and extent of the stenosis. CT was superior to bronchoscopy in the evaluation of the distal extent of the stenosis in two patients. In addition, CT is useful in ruling out external compression of the trachea by a mass or associated vascular anomaly. Prem Puri latrogenic Causes of Large Pleural Fluid Collections in the Premature Infant: Ultrasonic and Radiographic Findings. J. Amodio, S.
Abramson, I,IL. Berdon, et al. Pediatr Radiol 17:104-108, (February), 1987. Ten cases of large pleural collections, all of which were iatrogenically induced in premature infants, are presented. There were five instances of hypopharyngeal tears communicating with the right pleural space, three of chylothorax secondary to superior vena caval obstruction in patients undergoing total parenteral nutrition catheterization (TPN), and two of direct erosion by the inferior vena caval TPN catheter into the pleural space. Ultrasonography was most helpful in detecting these pleura/ collections. It is important to recognize the presence of pleural fluid in these infants as a marker of iatrogenic injury.--Prem Puri
Effects of Surgical Repair on Respiratory Mechanics in Congenital Diaphragmatic Hernia. H. Sakai, M. Tamura, Y. Hosokawa, et al. J
Pediatr 111:432-438, (September), 1987. To determine whether surgical repair of congenital diaphragmatic hernia (CHD) results in improvement in respiratory mechanics, the respiratory system compliance was measured in nine patients (five survivors and four nonsurvivors) before and after operation. In all nine infants, CHD was diagnosed within six hours of life, and surgical repair was through an abdominal approach after a period of stabilization. Measurements were made noninvasively using the passive expiratory flow-volume technique. In only one of the nine infants did compliance immediately improve after surgical repair, and in another it showed no change. Both of these infants survived, with an uneventful postoperative course. In the remaining seven infants, however, postoperative compliance immediately decreased from 10% to 77% from the preoperative value. The four infants with more than 50% decrease in compliance died with increasing hypoxemia and acidosis, These results suggest that respiratory mechanics in CHD, far from improving, frequently deteriorate as a result of repair of the hernia. The role of urgent surgery in this malformation should be reevaluated.--George Holcomb, Jr The Spectrum of Bronchopulmonary Foregut Malformations. N.
McMullin, O. Doi, and M. Kent. Pediatr Surg Int 2:304-306, (September), 1987. Bronchogenic cysts and pulmonary sequestrations have in the past been defined as separate congenital pathologic entities. The association of both in one mediastinal lesion is very rare. Such a case is reported and lends support to the concept that bronchogenic cysts and pulmonary sequestrations belong in a spectrum of bronchopulmonary malformations due to abnormal ventral budding of the primitive foregut. Their exact position in the spectrum is probably dependent on several independent key embryologic events.--Prem Puri Congenital Tracheal Stenosis: Role of CT and High kV Films. R.J. Hernandez and G.F. Tucker. Pediatr Radiol 17:192-196, (March), 1987.
Congenital tracheal stenosis is an intrinsic narrowing of the tracheal lumen due to complete cartilaginous rings. The authors
ALIMENTARY TRACT The Embryology of Usual and Unusual Types of Esophageal Atresia. D. Kluth and R. Habenicht. Pediatr Surg lnternat 2:223-227,
(July), 1987. Despite various theories, the pathogenesis of esophageal atresia is still unclear. The investigations of recent years seem to indicate that the leading role of the "septum tracheoesophageale" in normal and abnormal development of the foregut must be questioned. In this paper, new concepts of the pathogenesis of esophageal atresia are discussed with special consideration of the "unusual" types of atresia.--Prem Puri Treatment of Type A Esophageal Atresia Without Gastrostomy.
M. Carcassonne, M. Coquet and B. Kreitmann. Chirurgie 112:743745, (December), 1986. From 1973, gastrostomy had been omitted in the treatment of type A esophageal atresia. Two series were analyzed at the French Academy of Surgery: one in 1981 and the last one in 1986, From 1981 to 1986, of 54 patients, 39 were operated on without gastrostomy. No mortality was observed. The initial and late follow-up was uncomplicated. In 11 Waterston group C patients a gastrostomy was used. Three early deaths and one later death are reported. Gastrostomy is no longer considered useful in patients in good condition. Improvement of preoperative respiratory treatment should diminish the use of gastrostomy even in group C esophageal atresia.--J.M. Guys Oesophageal Atresia With Proximal Tracheo-oesophageal Fistula.
D. Cass and A. Auldist. Pediatr Surg Internat 2:212-215, (July), 1987. Esophageal atresia with proximal tracheoesophageal fistula is an uncommon subgroup comprising 2% of infants with esophageal atresia. Of those infants with esophageal atresia presenting with a gasless abdomen on initial abdominal x-ray, 23.5% had esophageal atresia with proximal tracheoesophageal fistula, and these infants thus warrant a careful study of the upper esophagus. The fistula may be difficult to demonstrate and the early appearance of contrast material in the trachea may be misinterpreted as due to aspiration or "spillover." All cases were treated differently, but a plan of manage-
494
ment evolved whose main features were the accurate demonstration of anatomy by preoperative contrast radiology, intraoperative assessment of the distal esophagus, and where possible, primary anastomosis. The authors recommend that a gastrostomy be routinely performed at the initial operation, at which time the length of the distal esophagus is assessed by the passage of a sound. If sufficient length is present, then an immediate primary anastomosis should be performed with thoracic ligation of the fistula if exposure is adequate. If at initial assessment the length of the gap is judged to be too long, the fistula should be divided via the appropriate route, cervical or thoracic, and alimentary continuity can be effected at a later time by delayed anastomosis or esophageal replacement. The major morbidity and mortality (40%) occurred in the group with a long gap between esophageal segments.--Prem Purl Oesophageal Atresia Without Fistula--Anastomosis or Replacement? N.A. Myers, S.W. Beasley, A.W. Auldist, et al. Pediatr Surg
Internat 2:216-222, (July), 1987. At the Royal Children's Hospital, Melbourne, 553 babies with esophageal atresia and/or tracheoesophageal fistula have been admitted during the past 39 years. Thirty-six (6.5%) of these had esophageal atresia without a tracheoesophageal fistula. Definitive surgery was performed in 27 patients: the primary definitive procedure was esophageal anastomosis in 15 and esophageal replacement in 12. Aspects of diagnosis and selection of the most appropriate treatment modality are discussed, with the results of treatment presented. The authors current policy is to perform an esophageal anastomosis whenever possible, and this has been successful in seven of the last 11 patients.--Prem Puri Esophageal Stenosis with Esophageal Atresia. M.A. Thomason
and B.B. Gay. Pediatr Radiol 17:197-210, (March), 1987.
Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition, the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with eosphageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.--Prem Purl Oesophageal Atresia and Vertebral Anomalies. D.R.V. Dickens and N.A. Myers. Pediatr Surg Internat 2:278-281, (September), 1987.
Esophageal atresia and/or tracheoesophageal fistula are relatively common congenital anomalies, occurring once in 3,000 births. Associated anomalies are seen frequently, and in a series of 538 patients admitted to the Royal Children's Hospital, Melbourne, 256 had additional anomalies (47.5%). Evaluation of the spine was possible in 345 patients and in 57, structural vertebral anomalies were present (16.5%). Of the 57 with a structural abnormality of the spine, 40 had an abnormality of formation, six an abnormality of segmentation, and ten had a combined defect. In the other patient, a bipartite cervical vertebra was present. Eight patients had scoliosis without a recognizable congenital spinal abnormality. In 81 there was a congenital rib abnormality. Fifty-six of this group had a normal spine, 24 had a structural abnormality of the spine, and in one patient scoliosis was present without a structural abnormality of the spine. Comparison is made between the authors findings and the
INTERNATIONAL ABSTRACTS
findings in other reported series and comments are made on the significance of spinal and/or rib anomalies in association with esophageal atresia.--Prem Purl Coexisting Left Diaphragmatic Hernia and Esophageal Atresia. R.
Udassin, O. Zamir, O. Peleg, et al. Pediatr Surg Internat 2:301-303, (September), 1987.
Coexisting left diaphragmatic hernia (DH) and esophageal atresia, a rare phenomenon, is described in two newborns, one with tracheoesophageal fistula (TEF) and the other without. The coexistence of DH and TEF in the one resulted in uncontrolled gastrointestinal distention with severe respiratory distress. Transabdominal division of the TEF was feasible and was performed concurrently with the diaphragmatic repair. Severe hypoplastic lungs and persistent pulmonary hypertension resulted in early postoperative death in both cases.--Prem Purl Congenital Tracheo-Oesophageal Fistula. N.A. Myers and K. Egami. Pediatr Surg Internat 2:198-211, (July), 1987.
At the Royal Children's Hospital, Melbourne, 28 patients with a congenital tracheoesophageal fistula were seen during a 38-year period, representing 5.2% of all babies seen with esophageal atresia and/or tracheoesophageal fistula. Diagnostic delay occurred frequently because of failure to appreciate the significance of the clinical picture. There was variation in the level of the fistula. The basic pattern of investigation and management is now quite uniform.--Prem Purl Mechanism of the Haemostatic Effect of Ethanolamine Oleate in the Injection Sclerotherapy for Oesophageal Varices. J.H. Kang, J.
Kambayashi, M. Sakon, et al. Br J Surg 74:50-53, (January), 1987.
In 20 patients undergoing injection sclerotherapy of esopahegal varices using ethanolamine oleate, the levels of two plasma fibrinopeptides (A and B 15-42) were raised one hour after injection and returned to preinjection levels after 48 hours. This indicates activation of coagulation and fibrinolysis. Plasma fibrinogen, which is regarded as a marker of inflammation, gradually increased to a maximum three days after injection. In vitro studies indicated that ethanolamine oleate prolonged clotting time and inhibited plasma fibrinopeptide A production due to chelation of calcium by the ethanolamine, whereas oleate alone shortened clotting time. The application of ethanolamine oleate and oleate alone to decapsulized rat kidney led to an increased accumulation of 12~I-labelled fibrinogen. The authors conclude that injection of ethanolamine oleate activates the local coagulation system; this may be accelerated by an acute inflammatory process.--N.P. Madden Fluoroscopically Controlled Removal of a Blunt Esophageal Foreign Body Using a Foley Catheter in Children. A. Hadary, P. Mogle, O.
Zamir, et al. Pediatr Surg lnternat 2:247-248, (July), 1987.
The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus. It reduces the risk, time, and expense involved in endoscopic removal. Prem Purl Congenital Microgastria. N.H. Aintablian, M.S. Slim, and B.W.
Antoun. Pediatr Surg Internat 2:307-310, (September), 1987.
An 81/z-year-old boy with microgastria associated with a sliding hiatal hernia and skeletal anomalies involving the spine and right