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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTERS TO THE EDITOR
Year : 2022  |  Volume : 27  |  Issue : 6  |  Page : 787-788
 

Tracheoesophageal fistula in a neonate with pneumoperitoneum. Is laparotomy mandatory?


1 Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India
2 Department of Pediatrics, Government Doon Medical College, Dehradun, Uttarakhand, India

Date of Submission29-May-2022
Date of Decision13-Jul-2022
Date of Acceptance21-Aug-2022
Date of Web Publication11-Nov-2022

Correspondence Address:
Sujit K Chowdhary
Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110 044
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_76_22

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How to cite this article:
Aditya M, Chowdhary SK, Kumar S. Tracheoesophageal fistula in a neonate with pneumoperitoneum. Is laparotomy mandatory?. J Indian Assoc Pediatr Surg 2022;27:787-8

How to cite this URL:
Aditya M, Chowdhary SK, Kumar S. Tracheoesophageal fistula in a neonate with pneumoperitoneum. Is laparotomy mandatory?. J Indian Assoc Pediatr Surg [serial online] 2022 [cited 2022 Dec 7];27:787-8. Available from: https://www.jiaps.com/text.asp?2022/27/6/787/360972




Sir,

Pneumoperitoneum associated with tracheoesophageal fistula (TEF) is a known entity, usually due to gastric perforation. Laparotomy, either before the TEF repair or in the same setting, was the mode of treatment in all such reported cases.[1],[2],[3] Here, we report a baby with TEF and pneumoperitoneum, who was managed without laparotomy with an excellent outcome.

We present a 3.1 Kg term baby diagnosed with TEF on X-ray showing coiling of the tube in the upper pouch with normal bowel gas pattern in the abdomen, referred to our hospital. At admission, the baby was hemodynamically stable on nasal prongs with no respiratory distress. Over 1 h, there was progressively tense abdominal distension, with increasing oxygen requirements. Since a repeat X-ray confirmed gross pneumoperitoneum [Figure 1], a peritoneal drain was placed. Over the next 24 h, the baby's abdomen remained soft and nondistended with no drainage from the peritoneal drain. Hence, we performed an upper gastrointestinal (GI) contrast study through the lower pouch at the time of thoracotomy, to confirm gastric perforation before proceeding to laparotomy, which revealed a normal outline of the stomach and intestine without any peritoneal leak [Figure 2]. Therefore, laparotomy was not done and just TEF repair was done. The GI contrast study repeated on POD-7 also showed normal passage of dye till the large bowel with no leak. The baby had an uneventful recovery and was growing well at 6 months of follow-up.
Figure 1: X-ray after 1 h after admission showing gross pneumoperitoneum

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Figure 2: Intraoperative gastrointestinal contrast study done through a feeding tube inserted into the lower esophagus. Delayed X-rays show dye has passed into the small bowel without any obvious extraluminal extravasation

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A small gastric perforation that has sealed spontaneously was a strong possibility. This case was presented as a simple intervention like a peritoneal drain and an intraoperative gastrointestinal contrast study excluded the need for an additional laparotomy. We believe that this approach should be used for similar presentation to reduce the morbidity of additional laparotomy after tracheoesophageal repair.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tahir LM, Cam L, Bahadir G, Anyawu P, Dambatta US, Dane S. Gastric Perforation in a Neonate with Trachea-Esophageal Fistula. Available from: https://www.jrmds.in/articles/gastric-perforation-in-a-neonate-with-tracheoesophageal-fistula.pdf. [Last accessed on 2021 Jul 30].  Back to cited text no. 1
    
2.
Rathod KK, Bawa M, Mahajan JK, Samujh R, Rao KL. Management of esophageal atresia with a tracheoesophageal fistula complicated by gastric perforation. Surg Today 2011;41:1391-4.  Back to cited text no. 2
    
3.
Holcomb GW 3rd. Survival after gastrointestinal perforation from esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1993;28:1532-5.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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