Spontaneous anastomosis of esophageal atresia without esophageal stricture formation: A case report

Introduction

Spontaneous esophago-esophageal fistulization is a reported phenomenon in cases of complex esophageal atresia, however, short and long-term complications are common, including stricture formation.

Case presentation

A male twin was born at 29 + 6 weeks gestation weighing 1103 g. Passage of a nasogastric tube was attempted but coiled in the upper esophagus, leading to a postnatal diagnosis of esophageal atresia with distal tracheo-esophageal fistula. At thoracotomy on day 1 of life, the tracheo-esophageal fistula was ligated without problems. Esophageal anastomosis to overcome a 1–1.5 vertebral body gap was attempted but abandoned following significant intraoperative anesthetic complications. Instead, the upper and lower esophageal ends were sutured closed and then apposed under tension using interrupted 4/0 Ethibond®. A contrast study on day 18 of life demonstrated spontaneous anastomosis of the esophageal ends, with reflux of contrast between the upper and lower esophagus, and no extraluminal contrast extravasation. Subsequent contrast studies at ages 4 weeks, 5, 10 and 13 months, and 2 years showed no anastomotic stricture. Upper gastrointestinal endoscopy at the age of 2 years showed no esophagitis. Gastro-esophageal reflux symptoms remain controlled with medication and no fundoplication has been performed. High resolution esophageal manometry at the age of 3 years demonstrated weak, but coordinated, distal peristalsis. At the age of 4.5 years, the patient is tolerating an unrestricted diet and has a growth curve that matches the curve of his twin sibling.

Conclusion

In cases where primary esophageal anastomosis is not possible, opposing the upper and lower pouches with sutures may result in spontaneous esophageal anastomosis not necessarily associated with an anastomotic stricture.