ESOPHAGEAL ATRESIA, DUODENAL ATRESIA AND ILEAL PERFORATION IN A 1000g PREMATURE NEONATE COMPLICATED BY A RECURRENT TRACHEOESOPHAGEAL FISTULA: A CASE PRESENTATION

Rainier Bence, Mohamed Abdelsalam, Corné de Vos

Division of Pediatric Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Abstract

Introduction: Esophageal atresia (EA) is a common congenital malformation of the upper gastrointestinal tract caused by failure of separation or incomplete foregut development. This rare congenital disease has known associated anomalies ranging from single to multiple congenital anomalies (MCA) including several known chromosomal abnormalities. A combination of duodenal atresia (DA) and EA in infants has been reported in 3 to 6% of EA cases. Added complications of gastric perforations, and even more rare intestinal perforations, make the management of these infants challenging and should be tailored to each patient’s clinical status. Despite advances in surgical techniques, complications such as recurrent fistula or stricture formation remain a

significant challenge. The rate of fistula recanalization after surgical repair has an estimated incidence of 5%. The known increase in mortality and morbidity of extremely low birth weight (ELBW) infants together with the presence of multiple congenital abnormalities lead to a high complication rate for these complex groups of EA patients.

Case Presentation: We report a single case of a 1000 g neonate born at30 weeks gestation, with a long-gap EA and a distal TEF, a duodenal atresia and cecal perforation that was later complicated by a recurrent

TEF.

Conclusion: This case highlights the importance of early diagnosis, optimizing surgical technique, prompt recognition of postoperative complications and a multidisciplinary approach to managing these complicated congenital conditions.