Management of oesophageal atresia
Authors: W. S. Walker
Journal: Thorax (1997)

The case reports by Zer et al, 1 Heriot and of particular importance in this case but definitive repair of the chest wall defect also cured Wells, 2 and Keane et al 3 have two features in common.As with all case reports they deal the paradoxical chest wall motion.This case serves as a reminder of the advantages of lateral with highly unusual situations but, more importantly, they concern the management of thought which provided an elegant surgical solution to an uncommon clinical situation.congenital abnormalities which either present in or may require surgical attention during Significant haemoptysis presents a difficult management problem to the thoracic surgeon.adult life.The management of oesophageal atresia can All too often an allegedly significant degree of haemoptysis is associated with poor diagnostic be complex.It is rarely possible simply to disconnect the frequently associated tracheo-information regarding the origin of the bronchial bleed and the nature of any coincident oesophageal fistula and to restore oesophageal continuity by direct anastomosis of the oeso-pathology.Bronchoscopy is frequently unrewarding as blood may be distributed through-phageal ends.If the oesophageal muscle coat is incised in a circular manner -a myotomy -out the bronchial tree.If there is no evidence of an obvious intrabronchial neoplasm, the the oesophageal mucosal tube elongates, providing the surgeon with a longer proximal cause is usually ascribed to the areas of probable cause such as bronchiectasis or putative ab-oesophageal segment and increasing the possibility of direct repair.The alternative to a normalities in the bronchial circulation.In the case described by Keane et al 3 the authors have direct repair is usually to use an interposed segment of colon.This strategy, however, whilst identified and confirmed an accessory cardiac bronchus as the causative lesion.Resection adequate in childhood, may leave a dilated and immobile oesophageal substitute with stenotic of the bronchus corrected the problem.They remind us of the importance of being aware of proximal and distal anastomoses in adult life.This situation is difficult to manage and may the possibility of an accessory bronchus which should occur in between one in 200 and one require major surgery to resect the colonic segment and restore continuity by creating a in 400 patients.This report contains several lessons.It is clear that thick slice computed gastric tube which is anastomosed to the cervical oesophagus.Primary oesophageal repair tomographic scanning is only a first pass investigation and repeated presentation with in infancy is therefore preferable.When, however, a myotomy has been used to create length, haemoptysis requires further investigation by a spiral examination.As they also observe, we the unsupported section of mucosa may dilate or "balloon" above an anastomosis, particularly must also be aware during the investigative process of the unusual -in this case the ac-when a degree of anastomotic narrowing is present.Again, colon substitution would be an cessory cardiac bronchus.This is a rare and interesting case which clearly identifies the need option but the use of a plastic repair procedure as described by Zer et al avoids the use of a to consider the possibility of an accessory bronchus as a cause of haemoptysis.It is also equally colonic conduit and hopefully, therefore, the consequent problems that may present to adult clear, however, that the likelihood of this origin is vanishingly low -hence this report -and, surgeons as the patient grows.Chest wall herniation and paradox due to from a surgical perspective, the important consideration must continue to be that common congenital absence or atresia of a rib or to marked divergence between ribs is uncommon.things happen commonly.Surgery to correct such a deformity for both 1 Zer M, Freud E, Grozovski S. Oesophageal plastic repair cosmetic and functional paradox reasons is for symptomatic ballooning following circular oesophageal Royal Infirmary of particularly rare.Heriot and Wells 2 have admyotomy and correction of oesophageal atresia.