Year: 2021
Type: article
Study design: Case Report
Abstract: Case reportIn July 2021, a 1.5-kg baby girl presented with polyhydramnios on antenatal ultrasound scan at 27 weeks that had resolved by 35 weeks.Physical examination showed no dysmorphic features.She was born by caesarean section at 35 weeks due to discordant growth in a dichorionic diamniotic twin pregnancy.She was intubated at birth but resistance was noted during orogastric tube insertion.Chest X-ray revealed coiling of the gastric tube at the upper pouch of the oesophagus with the presence of intestinal gas, which is a classic feature of type C oesophageal atresia (Fig 1).Echocardiogram revealed several cardiac anomalies including a ventricular septal defect, a moderate patent ductus arteriosus, and a large atrial septal defect.Thoracoscopic repair of oesophageal atresia was scheduled for the next day following stabilisation.The patient was positioned in a semiprone position with the right chest slightly elevated.She was put on conventional ventilation without single lung ventilation, as per our practice.A camera port was inserted at the 5th intercostal space and two further 5-mm working ports were inserted under direct vision.Pneumothorax of 3 to 4 mm Hg was created using CO 2 .The azygous vein was cauterised and divided with monopolar diathermy and the tracheoesophageal fistula readily identified.This was closed by Weck Hem-o-lok (Teleflex; Wayne [PA], United States) and divided (Fig 2).The proximal oesophageal stump was identified and opened with scissors.End-to-end esophago-oesophagostomy was performed using single-layer interrupted 5/0 polydioxanone sutures (Ethicon; Bridgewater [NJ], United States).A 12-Fr chest drain was inserted at the end of the procedure.The operation was uneventful and completed in 145 minutes.After surgery, the patient was managed in the neonatal intensive care unit according to our usual protocol.On day 1 after surgery she developed sudden profound desaturation with CO 2 retention when the endotracheal tube was secured at 8 cm
Source: Hong Kong Medical Journal
DOI: 10.12809/hkmj219857
Institution: Queen Mary Hospital
Language: English
Topic: Esophageal and GI Pathology
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4200545003