Median sternotomy approach for the repair of esophageal atresia: a case report
Abstract Background Repair of esophageal atresia is usually performed through the right thoracic cavity. However, when the upper pouch of the esophagus and tracheoesophageal fistula (TEF) is located in the thoracic inlet and completely on the left side of trachea, it is difficult to dissect and anas...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-09-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-022-01523-5 |
| _version_ | 1798002886584565760 |
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| author | Hiroaki Fukuzawa Mitsumasa Okamoto Yudai Tsuruno Ayako Maruo |
| author_facet | Hiroaki Fukuzawa Mitsumasa Okamoto Yudai Tsuruno Ayako Maruo |
| author_sort | Hiroaki Fukuzawa |
| collection | DOAJ |
| description | Abstract Background Repair of esophageal atresia is usually performed through the right thoracic cavity. However, when the upper pouch of the esophagus and tracheoesophageal fistula (TEF) is located in the thoracic inlet and completely on the left side of trachea, it is difficult to dissect and anastomose the esophagus through the right thoracic cavity. We present a case of esophageal atresia, with the esophageal upper pouch located high and completely on the left side of trachea, successfully repaired via the median sternotomy approach. Case presentation A male neonate with a birth weight of 1766 g was prematurely delivered via cesarean section at 34 weeks of gestation. Contrast-enhanced computed tomography (CT) showed that the upper pouch of the esophagus was located at the thoracic inlet and completely on the left side of the trachea; hence, a diagnosis of esophageal atresia was made. Moreover, a TEF was connected to the trachea at the level of the lower end of the upper esophageal pouch. An aberrant right subclavian artery and persistent left superior vena cava were also detected. Esophageal dissection and anastomosis were determined to be very difficult if approached from the right thoracic cavity. Therefore, we performed median sternotomy one day after the neonate was born. The upper pouch of the esophagus and TEF were easily dissected via the median sternotomy approach. Anastomosis of the esophagus was performed, with a good visual field, to the left of the trachea. The postoperative course was uneventful. Conclusions This is the first reported case of a median sternotomy approach for esophageal atresia. This technique may be useful when a right thoracic approach is difficult, especially if the esophageal upper pouch is located completely to the left of the trachea or if it is higher than the normal position. |
| first_indexed | 2024-04-11T12:00:33Z |
| format | Article |
| id | doaj.art-23478a2bdffe4103b6a4f22cab76aa83 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-04-11T12:00:33Z |
| publishDate | 2022-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-23478a2bdffe4103b6a4f22cab76aa832022-12-22T04:24:53ZengSpringerOpenSurgical Case Reports2198-77932022-09-01811410.1186/s40792-022-01523-5Median sternotomy approach for the repair of esophageal atresia: a case reportHiroaki Fukuzawa0Mitsumasa Okamoto1Yudai Tsuruno2Ayako Maruo3Department of Pediatric Surgery, Japanese Red Cross Society Himeji HospitalDepartment of Pediatric Surgery, Japanese Red Cross Society Himeji HospitalDepartment of Pediatric Surgery, Japanese Red Cross Society Himeji HospitalDepartment of Cardiovascular Surgery, Kakogawa City HospitalAbstract Background Repair of esophageal atresia is usually performed through the right thoracic cavity. However, when the upper pouch of the esophagus and tracheoesophageal fistula (TEF) is located in the thoracic inlet and completely on the left side of trachea, it is difficult to dissect and anastomose the esophagus through the right thoracic cavity. We present a case of esophageal atresia, with the esophageal upper pouch located high and completely on the left side of trachea, successfully repaired via the median sternotomy approach. Case presentation A male neonate with a birth weight of 1766 g was prematurely delivered via cesarean section at 34 weeks of gestation. Contrast-enhanced computed tomography (CT) showed that the upper pouch of the esophagus was located at the thoracic inlet and completely on the left side of the trachea; hence, a diagnosis of esophageal atresia was made. Moreover, a TEF was connected to the trachea at the level of the lower end of the upper esophageal pouch. An aberrant right subclavian artery and persistent left superior vena cava were also detected. Esophageal dissection and anastomosis were determined to be very difficult if approached from the right thoracic cavity. Therefore, we performed median sternotomy one day after the neonate was born. The upper pouch of the esophagus and TEF were easily dissected via the median sternotomy approach. Anastomosis of the esophagus was performed, with a good visual field, to the left of the trachea. The postoperative course was uneventful. Conclusions This is the first reported case of a median sternotomy approach for esophageal atresia. This technique may be useful when a right thoracic approach is difficult, especially if the esophageal upper pouch is located completely to the left of the trachea or if it is higher than the normal position.https://doi.org/10.1186/s40792-022-01523-5Esophageal atresiaMediastinumMedian sternotomyTracheoesophageal fistula |
| spellingShingle | Hiroaki Fukuzawa Mitsumasa Okamoto Yudai Tsuruno Ayako Maruo Median sternotomy approach for the repair of esophageal atresia: a case report Surgical Case Reports Esophageal atresia Mediastinum Median sternotomy Tracheoesophageal fistula |
| title | Median sternotomy approach for the repair of esophageal atresia: a case report |
| title_full | Median sternotomy approach for the repair of esophageal atresia: a case report |
| title_fullStr | Median sternotomy approach for the repair of esophageal atresia: a case report |
| title_full_unstemmed | Median sternotomy approach for the repair of esophageal atresia: a case report |
| title_short | Median sternotomy approach for the repair of esophageal atresia: a case report |
| title_sort | median sternotomy approach for the repair of esophageal atresia a case report |
| topic | Esophageal atresia Mediastinum Median sternotomy Tracheoesophageal fistula |
| url | https://doi.org/10.1186/s40792-022-01523-5 |
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