Recanalization of an Esophageal Atresia Anastomosis by an Interventional Radiologic Technique

Abstract

A new tool using the interventional radiology technique of transjugular intrahepatic portosystemic shunt (TIPS) is presented as a method to recanalize a failed esophageal anastomosis in a premature infant.

Case Report:

The 1.5-kg patient was born at 31 weeks with esophageal atresia (EA) and a distal tracheoesophageal fistula (TEF). Because of a long gap, division of the TEF and gastrostomy were performed. Two months later, she underwent a delayed primary esophageal anastomosis. The contrast study showed the proximal pouch to be connected to a false lumen. Endoscopic recanalization was unsuccessful. Under fluoroscopic control, the needle used for TIPS was introduced through the gastrostomy, pushed through the membrane of the false channel, and grabbed by a snare introduced through the mouth. A wire was left in place. The lumen was sequentially dilated by means of a combination of pneumatic and bougie dilations to 36F. The patient required a total of 12 dilations during a period of 2 months after the initial recanalization. She expired 2 months after the last dilation of unrelated sepsis. At the time of her death, no clinical evidence of stricture was found.

Conclusions:

Obliteration of the anastomosis by a false lumen is a rare complication of EA repair. Spontaneous fistulization did not occur. Applying our technique, we were able to recanalize the lumen and dilate it to an adequate size, sparing the patient a third thoracotomy. This technique can be applied to cases of severe stricture when a lumen cannot be established by standard methods.