Tracheoesophageal Fistula Complicated by Iatrogenic Gastric Perforation in a Low Birth Weight Neonate

Abstract

Type-III tracheoesophageal fistula is the commonest type of fistula where upper pouch is blind and distal oesophageal pouch communicates with trachea. In this condition, gastric distension is a common manifestation which can be worsened by positive pressure ventilation. Pulmonary pathology may necessitate ventilation with high peak airway pressures which may rarely lead to gastric perforation with serious consequences. We are reporting such a case of gastric perforation during ventilatory management for fistula repair which needed surgical repair. Keywords: Airway management; esophageal atresia; gastric perforation; tracheo-oesophageal fistula.

Sleeve gastrectomy for multiple gastric perforations in a preterm: A case report

“…8 Defects in the muscular layer of the gastric wall, especially among preterms, during ventilatory management for tracheo-esophageal fistula repair, hypoxic/ischemic necrosis and perforation, sepsis, duodenal/jejunal obstruction, use of the ibuprofen-paracetamol, necrotizing enterocolitis, excessive feeding are the reported causes of gastric perforation. 7,[9][10][11][12][13][14] In premature infants, owing to the fragility of the gastric wall, relatively minor traumatic events (insertion of nasogastric tube and/or gastric distension during bag-mask ventilation) may bring about a local gastric wall disruption and perforation. 7 In the case of a punctate perforation, a traumatic factor should be considered, such as the use of gastric tubes.…”

First case report of spontaneous perinatal gastric perforation in premature neonate with potter sequence and syndrome

“…Gastric perforation in neonates is a condition that causes high health costs, morbidity, high risk of mortality and disability, regardless of the cause. Muscle defects or absence of the muscular layer of the gastric wall, iatrogenesis in the management of tracheoesophageal fistulas, hypoxia/ischemia, early sepsis, duodenal/jejunal obstruction, use of ibuprofen-paracetamol, esophageal atresia, administration of orogastric catheter, among others, are some of the causes reported in the literature [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] . Gastric perforation as a complication of Potter's syndrome has not been reported among the case series and case reports published so far [3] , [4] , [5] , [17] , [18] , [19] .…”