Work

From stridor to symptom relief; management of pediatric Kommerell's diverticulum and vascular rings in Palestine [2016–2024]: a single center cohort study

Year: 2025

Type: article

Abstract: Background: Kommerell's diverticulum (KD) with vascular rings is an uncommon cause of pediatric airway and feeding symptoms, and data from the Arab region are scarce. We report a Palestinian cohort of all diagnosed and managed cases, describing presentation, diagnostics, and management. Methods: We retrospectively studied all children at Al-Makassed Hospital (Jerusalem) from 2016 to 2024 who were diagnosed with vascular rings + KD confirmed by imaging or intra-operative findings. We abstracted demographics, symptoms, test performance, anatomy, treatments, and peri-operative course and follow-up. Primary outcomes were diagnostic yield and improvement at last visit. Results: Fourteen patients were included; median age at diagnosis was 8 months (IQR 2-15), symptom onset 15 days (0-83). Thirteen (92.9%) were symptomatic; stridor (64.3%), recurrent wheeze (35.7%), and dysphagia/choking (28.6%) predominated; 42.9% had prior misdiagnoses. Barium swallow was positive in 7/8 (87.5%), echocardiography in 5/9 (55.6%), bronchoscopy in 10/12 (83%), and CT angiography (CTA) confirmed anatomy in 13/13 (100%). Anatomy included right aortic arch (RAA) with aberrant left subclavian artery in 8/14 (57.1%), double aortic arch in 4/14 (28.6%), and innominate artery compression in 2/14 (14.3%); 57.1% had minor intracardiac anomalies. Thirteen children (92.9%) underwent surgery (ligamentum division, diverticulectomy ± subclavian transfer, aortopexy, or double-arch division); one mild innominate compression case was observed. All were discharged alive; one late death occurred. At last follow-up, 7/13 survivors were asymptomatic and 6/13 had residual but improved symptoms. Median hospital stay was 18 days (IQR 7-25). Conclusion: KD-associated rings present early yet are frequently delayed in diagnosis. CTA is definitive, and tailored surgery yields meaningful, often complete, symptom relief with acceptable morbidity.

Source: Frontiers in Pediatrics

DOI: 10.3389/fped.2025.1713368