Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children.

BACKGROUND: The jejunal interposition is our preferred esophageal replacement route when the native esophagus cannot be reconstructed. We report the evolution of our approach and outcomes. METHODS: The study was a single-center retrospective review of children undergoing jejunal interposition for esophageal replacement. Outcomes were compared between historical (2010-2015) and contemporary cohorts (2016-2019). RESULTS: Fifty-five patients, 58% male, median age 4 years (interquartile range 2.4-8.3), with history of esophageal atresia (87%), caustic (9%) or peptic (4%) injury, underwent a jejunal interposition (historical cohort n = 14; contemporary cohort n = 41). Duration of intubation (11 vs 6 days; P = .01), intensive care unit (22 vs 13 days; P = .03), and hospital stay (50 vs 27 days; P = .004) were shorter in the contemporary cohort. Anastomotic leaks (7% vs 5%; P = .78), anastomotic stricture resection (7% vs 10%; P = .74), and need for reoperation (57% vs 46%; P = .48) were similar between cohorts. Most reoperations were elective conduit revisions. Microvascular augmentation, used in 70% of cases, was associated with 0% anastomotic leaks vs 18% without augmentation; P = .007. With median follow-up of 1.9 years (interquartile range 1.1, 3.8), 78% of patients are predominantly orally fed. Those with preoperative oral intake were more likely to achieve consistent postoperative oral intake (87.5% vs 64%; P = .04). CONCLUSION: We have made continuous improvements in our management of patients undergoing a jejunal interposition. Of these, microvascular augmentation was associated with no anastomotic leaks. Despite its complexity and potential need for conduit revision, the jejunal interposition remains our preferred esophageal replacement, given its excellent long-term functional outcomes in these complex children who have often undergone multiple procedures before the jejunal interposition.

Gastroesophageal reflux disease in children and adolescents in primary care.

OBJECTIVES: To determine the prevalence and incidence of a diagnosis of gastroesophageal reflux disease (GERD) in children and adolescents in UK primary care, and to assess comorbidities that are associated with a diagnosis of GERD. MATERIAL AND METHODS: Incident GERD cases during 2000-05 were identified from The Health Improvement Network (THIN) UK primary care database via a computer search for diagnostic codes for GERD, followed by manual review of the patient records. RESULTS: We identified 1700 children with a first diagnosis of GERD during 2000-05. The incidence of GERD was 0.84 per 1000 person-years. The incidence decreased with age from 1.48 per 1000 person-years among 1-year-old children until the age of 12 years, whereupon it increased to a maximum at 16-17 years of 2.26 per 1000 person-years for girls and 1.75 per 1000 person-years for boys. Pregnant adolescents were not included in the study. In addition to typical GERD symptoms (epigastric pain, heartburn, reflux, regurgitation), 21.2% of children reported nausea or vomiting. Children with neurological disorders were at increased risk of a GERD diagnosis. Hiatus hernia and congenital esophageal disorders were also associated with a diagnosis of GERD. Children and adolescents using antiepileptics, oral/inhaled steroids, beta-agonists and paracetamol had an increased risk of a GERD diagnosis. CONCLUSIONS: The incidence of a GERD diagnosis was age-dependent and was highest among very young children and older female adolescents. Children with neurological impairments and other comorbidities were at increased risk of a GERD diagnosis.

Laparoscopic surgery for an esophageal duplication cyst using a near-infrared indocyanine green fluorescence system: A case report.

We herein describe a case of laparoscopic surgery for an esophageal duplication cyst using a near-infrared indocyanine green fluorescence system. A 64-year-old woman with a cystic tumor adjacent to the esophagogastric junction was referred to our hospital for treatment. Esophagogastroduodenoscopy and abdominal CT revealed a 70-mm submucosal tumor derived from the abdominal esophagus. We performed laparoscopic resection and then evaluated the tissue perfusion of the abdominal esophagus by using a near-infrared indocyanine green fluorescence system. A Dor fundoplication was performed to prevent postoperative gastroesophageal reflux disease and reinforce the mucosal layer defect. The postoperative course was uneventful, and pathological evaluation confirmed that the tumor was an esophageal duplication cyst. The patient did not develop recurrence in the 24 months after surgery. We have demonstrated that laparoscopic resection of an esophageal duplication cyst may be performed effectively with intraoperative assessment of tissue perfusion using a near-infrared indocyanine green fluorescence system.

Structural autosomal imbalance and oesophageal defects: addendum to the article by Felix et al. (2007).

Information about approximately 25 additional cases of oesophageal defects in patients with structural autosomal imbalance (in addition to 30 cases already mentioned in the article by Felix et al.) may facilitate search for the genes responsible for these defects.

Foregut Duplication Cysts in Children.

BACKGROUND AND OBJECTIVES: Duplications of the alimentary tract are rare anomalies. We report our experience with foregut duplication cysts including their clinical presentation, diagnostic modalities, and surgical management. METHODS: We report a 20-year retrospective review of all foregut duplication cysts managed at our institution. RESULTS: Twelve patients with 13 foregut duplication cysts were identified. The ages of the children at the time of surgery ranged from infancy to adolescence, with a mean age of 7.2 years. Half of the patients presented with abdominal pain and vomiting, and the remaining either had respiratory distress or were asymptomatic. All resections were performed electively. Two of the 11 patients had other congenital anomalies, including a congenital pulmonary airway malformation and coarctation of the aorta. One patient had prenatal diagnosis by ultrasonography. Nine patients underwent complete successful excision with no complications. Three patients whose symptoms resolved during hospitalization remained under observation because of parental preference. CONCLUSIONS: Foregut malformation in children may present with a variety of symptoms or can be found incidentally. The decision and timing of surgery is based on the clinical presentation. Surgical intervention in asymptomatic patients should be based on a thorough discussion with the parents.

Colon replacement of the esophagus for congenital and benign disease.

Over the past 28 years, one of us (W. E. N.) has reconstructed the esophagus with the right colon for congenital and benign disease in 84 patients. The first patient in the series, who was operated on in 1955, remains asymptomatic. Nine patients had congenital tracheoesophageal fistula with atresia; 4, esophageal varices; 30, advanced obliterative esophagitis; and 23, corrosive destruction. In 7, severe esophagitis followed esophagogastrectomy; 4 had unsuccessful operations for achalasia; and 7 had colon bypass following esophageal perforation. Eleven early nonfatal complications occurred. Late nonfatal complications were seen in 6 patients. There were 4 early deaths (4%): following dehiscence of an intrathoracic esophagocolic anastomosis and 1 due to peritonitis. Four individuals died over the years, and 5 patients were lost to follow-up. The late results in 71 patients show that 60 (84.5%) believe they have a satisfactory result. Nine (13%) individuals are symptomatic, and 2 (2.8%) must be classified as failures. Early complications have been minimized by using preoperative intestinal angiography, anastomotic stapling techniques, and the Doppler study intraoperatively to prognosticate colon blood flow. Several important observations have been made: anastomosis in the neck is preferable; the transplanted colon dilates from loss of motor activity but is functionally adequate; an isoperistaltic segment is preferable, but an antiperistaltic implant suffices; colonic mucosa is relatively resistant to acid-peptic digestion; and hyperalimentation is mandatory in very ill and debilitated patients.

White sponge nevus presenting in the esophagus--case report and literature review.

White sponge nevus (WSN) is a rare inherited disorder which usually presents as non-painful white plaques primarily involving the buccal mucosa, gingiva and palate. Extra-oral lesions most often occur in the esophagus or anogenital area but almost invariably follow the development of typical buccal lesions. We present a non-familial case in which the first manifestation of the disease was in the esophagus in the absence of oral lesions. This sequence of events has not previously been reported in the literature. The cytohistological and electron microscopical appearances which allow the recognition and differentiation of WSN from other conditions presenting as esophageal white lesions are discussed.

Congenital diaphragmatic hernia associated with a gastroesophageal duplication cyst: a case report.

Severe left congenital diaphragmatic hernia was diagnosed in a baby prenatally, and she underwent hernia repair on the sixth postnatal day of life. She was found to have a huge symptomatic gastroesophageal duplication cyst on day 24 of life. A thoracoabdominal dissection allowed successful cyst excision. J Pediatr Surg 36:626-628.

Congenital bronchoesophageal fistula associated with esophageal diverticulum in the adult.

Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.

[Abdominal paraesophageal bronchogenic cyst]. / Kyste bronchogénique para-oesophagien abdominal.

We report a case of abdominal paraesophageal bronchogenic cyst in a 19 year-old patient who complained of dysphagia. Based on this exceptional finding, the authors state overview the pathogenic theories and the histologic features which distinguish para-esophageal bronchogenic cysts from duplications. Preoperative diagnosis is difficult, but endoscopic ultrasound seems to be the imaging method of choice.

[Congenital oesophageal stenosis due to tracheobronchial remnants]. / Congenitale Oesophagusstenose durch tracheobronchiale Reste.

This paper presents the authors' experience with congenital oesophageal stenosis (= CES) in three patients who had CES due to tracheobronchial remnants. Difficulties with feeding started at 6-9 months of age, which corresponded with the introduction of solids. Contrast studies showed stenosis at the junction of the mid and distal thirds of the oesophagus. Limited resection of the oesophageal stenosis and primary anastomosis was performed in all three patients with good results. CES should be suspected if all other causes of oesophageal stenosis have been excluded by upper gastrointestinal examinations, endoscopy, oesophageal pH monitoring and oesophageal manometry.

Congenital esophageal stenosis owing to tracheobronchial remnants.

OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal stenosis due to tracheobronchial remnants, since its treatment differs from other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial remnants, whose definitive diagnosis was made by histopathology. Except for the last case, in which a concomitant anti-reflux surgery was not performed, all had a favorable outcome after resection and anastomosis of the esophagus. COMMENTS The congenital esophageal stenosis is an intrinsic narrowing of the organ's wall associated with its structural malformation. The condition can be caused by tracheobronchial remnants, fibromuscular stenosis or membranous diaphragm and the first symptom is dysphagia after the introduction of solid food in the diet. The first-choice treatment to tracheobronchial remnants cases is the surgical resection and end-to-end anastomosis of the esophagus.

A rare congenital neck lump.

We describe the case and present a radiological image of a neck lump identified antenatally with ultrasound imaging. Postnatally a left-sided asymptomatic neck lump was identified in the left posterior triangle of the neck. Repeat ultrasound and CT imaging were arranged confirming a cyst adjacent to the cervical oesophagus and displacing the carotid sheath anteriorly. Complete cyst excision was achieved with no complications. Histological analysis identified a 30×22×20 mm cyst with a smooth muscle layer within the cyst wall and a lining of respiratory epithelium. These findings were consistent with a diagnosis of cervical duplication cyst (CDC). Proximity to the carotid sheath and oesophagus can make CDC excision potentially dangerous hence preoperative CT scanning was useful to establish the anatomical relations of the cyst in this case.

Gastrointestinal images: complete tubular duplication of the oesophagus in an adult.

INTRODUCTION: Duplication of the oesophagus is a rare congenital abnormality that usually presents in children. Presentation in adults is extremely rare. CASE HISTORY: We report a case of a19-year-old gentleman presenting with general gastrointestinal symptoms of pain and dysphagia. Diagnosis was made with CT and contrast studies, demonstrating complete tubular duplication of the oesophagus with communications at both ends of the duplication. The patient was managed conservatively. DISCUSSION: We describe the difficulty in diagnosing these rare congenital abnormalities. We recommend that with a multi-disciplinary approach, conservative management can be considered.

Cervical esophageal duplication cyst: case report and review of the literature.

Cervical esophageal duplication cysts are rare congenital anomalies that can be successfully managed surgically. These anomalies are rare causes of upper airway obstruction. We present here a case of a cervical esophageal duplication cyst in an infant, along with a review of the literature concerning this anomaly.