A novel variant of esophageal atresia with tracheo-esophageal fistula with a crossed-over proximal esophageal pouch: a diagnostic dilemma

Abstract

Diagnosis of esophageal atresia (EA) with tracheo-esophageal fistula (TEF) can be easily done in newborns with symptoms of excessive salivation and failure to pass infant-feeding tube (IFT) into the stomach. There are many reports in the literature which describe the diagnostic pitfall of this IFT test. We describe a case of a neonate with EA with TEF in which the upper atretic esophageal pouch had grown long enough to reach up to the level of diaphragm, thus allowing the IFT to go up to significant distance from the alveolus giving the radiograph as if the tube is in the upper part of stomach, thus creating a diagnostic dilemma.

Esophageal atresia with distal fistula and long overlapping upper esophageal pouch

“…They described this anomaly as partial duplication of the atretic upper esophageal pouch. Recently, we reported a similar case in which the crossed over upper esophageal pouch had extended down to the level of the diaphragm [4]. Our previous case posed a difficult diagnostic challenge because even the chest radiograph gave the impression that the IFT was in the upper part of the esophagus.…”

Kluth type iiib6esophageal atresia: Diagnostic dilemma and pitfalls of using infant feeding tube

“…[ 2 ] (iii) It may pass up to a significant length in the elongated, overgrown upper esophageal pouch (as seen in our cases). [ 3 4 5 6 7 8 ] This leads to delayed diagnosis, and therefore, its use is to be deprecated in ruling out EA; instead use of no. 10 sterile, blunt-tipped red rubber catheter cannot be overemphasized shortly after birth.…”

“…In contrast study with IFT or catheter in situ , the upper pouch was reaching the diaphragm. [ 5 7 8 ] This change in the level of upper pouch may be due to the elastic recoil of the dilated upper pouch in Kluth Type IIIb 6 variant. If the level of upper pouch is observed to be same in both the radiographs (with and without catheter), other possibilities such as esophageal stenosis and web (absence of recoil) may also be considered.…”

“…[ 2 3 ] We describe our experience with EA with tracheoesophageal fistula (TEF) and long overlapping upper esophageal pouch, along with mini-review of literature. [ 3 4 5 6 7 8 ]…”

A Preoperative Diagnostic Challenge of a Long Overlapping Upper Pouch with Distal Tracheoesophageal Fistula

“…Rathod et al showed that the traditional infant-feeding tube test was unreliable in such a case [2]. Rathod et al also reported that the presence of a long overlapping pouch may be the reason for a late diagnosis and delayed referral [3].…”