Naslov
Intercostal muscle flap for recurrent tracheoesophageal fistula repair: a case report

Autori
Dalipi, Aida ; Sabolić, Ivana ; Pasini, Miram ; Papeš, Dino ; Ćavar, Stanko ; Antabak, Anko ; Luetić, Tomislav

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
9th Croatian Congress of Pediatric Surgery with International Participation - Book of abstracts / - , 2022, 19-19

Skup
9th Croatian Congress of Pediatric Surgery with International Participation

Mjesto i datum
Pula, Hrvatska, 21.09.2022. - 24.09.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Nije recenziran

Ključne riječi
recurrent tracheo-esophageal fistula, intercostal muscle flap

Sažetak
Recurrent tracheoesophageal fistula (rTEF) occurs in up to 15% of patients after initial repair of esophageal atresia with TEF (EA/TEF) and is challenging to manage. We report surgical management of rTEF using an intercostal muscle flap to buttress tracheal and esophageal repair sites. Term female neonate born with EA/TEF, shortly after birth underwent thoracotomy with ligation of TEF and oesophageal anastomosis. First postoperative esophagogram showed satisfactory postoperative results. Recovery period was complicated with two episodes of aspiration pneumonia caused by gastroesophageal reflux. After discharge, patient started frequently vomiting and coughing after feeds, had recurrent mild respiratory infections and was faltering in growth. At 6 months, she had an esophagogram which showed an anastomotic stricture and suspected rTEF. Three consecutive endoscopies performed for balloon dilatation of anastomotic stricture did not detect any site of recurrent TEF. At the age of 1.5 years, she developed severe bilateral pneumonia. Performed diagnostic bronchoscopy did not detect a fistula site, however repeated esophagogram confirmed a significant rTEF. After recovery from pneumonia, she underwent a preoperative bronchoscopy which confirmed rTEF above the carina at the site of a small postoperative diverticulum. Thoracotomy was performed and we found a fistula between trachea and esophagus below the anastomotic site. Fistula was ligated and oesophagus repaired. An intercostal muscle flap was harvested from the right third intercostal space and transfixed over the suture line of esophagus forming a protective layer in between the repaired trachea and esophagus. Postoperative course was prolonged due to pneumonia. Routine esophagogram showed no anastomotic leak or stenosis. Child was discharged in good condition. On regular follow up she is tolerating solid food, has no respiratory issues and has regained growth. Intercostal muscle flap is feasible for surgical management of rTEF with an excellent postoperative outcome.

Izvorni jezik
Engleski

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