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Symptomatic Acquired tracheal diverticulum after type III esophageal atresia: endoscopic treatment

D. Weil*, L. Laccourreye **, MO. Foucher **, JP. Monrigal ***, H. Charrot **, L. Coupris*, J. Dubin **

* Department of Visceral Pediatric Surgery, Pediatric Unit, CHU Angers

** ORL Department, CHU Angers

*** Department of Anesthesiology, Intensive Care Unit, CHU Angers, France

 

ABSTRACT

Introduction: The respiratory complications after the treatment for oesophageal atresia with eso-tracheal fistula (ETF) are frequent. Our observation reports acute and chronic respiratory accidents related to an acquired tracheal diverticulum, ETF relapse, with successful endoscopic treatment.

Material and methods: The diagnosis of type III oesophageal atresia, with Pierre Robin like, was made at birth. The baby was operated after few hours from birth (closure of the ETF and termino-terminal anastomosis).

Results: Postoperative the extubation was not possible justifying a tracheotomy at two months of life. In spite of that, the child had several episodes of respiratory distress. Endoscopic controls were necessary for repositioning of the intubation canula. Endoscopy revealed a deep posterior tracheal diverticulum, corresponding to the ETF site, distended by positive pressure that determined intermittent incarceration of the intubation canula at its distal end. At the age of 4years old, a few weeks after a laparoscopic fundoplication, in order to minimize the inflammation of the aero-digestive cross-roads and to improve the poor growth of the child, the endoscopic treatment of the pathogenic diverticulum was performed. It consisted of collapsing the posterior wall of the diverticulum by electrocoagulation, using a sheathed catheter for Deflux* (Film); the suspension laryngoscopy didn’t allow a direct vision of the trachea in this child with Pierre Robin like.

Conclusion: This complication should be searched systematically in case of persistent respiratory symptomatology, in children operated on for oesophageal atresia with ETF or for isolated ETF. The endoscopic collapsing of the posterior wall of the diverticulum, with standard Laser or electrocoagulation by tracheoscopy, Ligasure (Valleylab) or Ultracision Harmonic Scalpel (Johnson and Johnson Gateway) by suspension laryngoscopy, is a simple, radical and elegant method of treatment.

 

Key words: oesophageal atresia, eso-tracheal fistula , tracheal diverticulum, endoscopic treatment