Gastric perforation in infants with oesophageal atresia and distal tracheo-oesophageal fistula

• Published in: Pediatric surgery international Vol. 15; no. 1; pp. 24 - 27
• Main Authors: MAOATE, K, MYERS, N. A, BEASLEY, S. W
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.01.1999; Berlin Springer Nature B.V
• Subjects: Abnormalities, Multiple - surgery; Algorithms; Biological and medical sciences; Catheterization; Esophageal Atresia - complications; Esophageal Atresia - surgery; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Malformations; Medical sciences; Respiration, Artificial - adverse effects; Stomach Rupture - etiology; Stomach Rupture - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tracheoesophageal Fistula - complications; Tracheoesophageal Fistula - surgery; Treatment Outcome; Human; Stomach; Tracheoesophageal; Perforation; Pneumoperitoneum; Esophageal disease; Fistula; Congenital disease; Esophagus; Newborn; Treatment; Prematurity; Malformation; Surgery; Atresia; Digestive diseases; Complication; Early; Gastric disease
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s003830050504

Gastric perforation (GP) is a well-recognised complication of oesophageal atresia (OA) with distal tracheo-oesophageal fistula (TOF), and is usually associated with extreme prematurity, hyaline membrane disease, and the requirement for assisted ventilation. The presentation is sudden, and leads to further deterioration in respiratory function because of increasing abdominal distension from pneumoperitoneum and splinting of the diaphragm. Unrelieved, the infant becomes increasingly hypoxic and may die. A review of six infants with OA and distal TOF in whom GP occurred has enabled us to develop the following guidelines for the appropriate initial surgical management of this complication: (1) Needle paracentesis of the abdomen en route to surgery if the infant continues to deteriorate; (2) Urgent laparotomy to decompress the abdomen and to occlude the lower oesophagus with a catheter introduced through the GP; (3) Thoracotomy and division of the fistula; (4) Oesophageal anastomosis if the infant's condition improves sufficiently and the anatomy is favourable; and (5) Repair of the GP and formation of a gastrostomy.