A NEWBORN WITH DOUBLE ATRESIA: ESOPHAGEAL WITH DISTAL TRACHEOESOPHAGEAL FISTULA FOLLOWED BY CONCOMITANT ANAL ATRESIA: A CASE REPORT

Abstract

Esophageal atresia (EA) represents the most frequent congenital anomaly of the upper gastrointestinal tract in newborns with estimated incidence of one in 2500-4500 newborns worldwide. We present a rare case report of a newborn with double atresia, esophageal with distal fistula followed by anal atresia. A one-day-old male newborn was admitted to the Department of Pediatric Surgery at the Clinical Hospital Acibadem Sistina, Skopje, with the chief medical complaints of difficulty breastfeeding, vomiting and respiratory distress. After the initial clinical examination, and based on the medical history and physical findings, RTG revealed esophageal atresia with a distal fistula, followed by the identification of anal atresia. An urgent indication for surgical treatment was established, and a three-stage surgical plan was devised. In the first stage, the fistula was resected, followed by T-T esophageal anastomosis and sigmoidostomy. In the second stage, a laparoscopic pull-through Soave procedure was performed. The third and final surgical intervention was closure of the sigmoidostomy. On the seventh postoperative day (the primary procedure), an esophagogram showed adequate passage of contrast agent into the distal portion of the esophagus and stomach, with no fistulas. Neurological check-up showed normal EMG conducting of the anal sphincter. Esophageal atresia represents a surgical pathology with an overall survival rate of 85%–95%. The prognosis is corresponding to the presence of associated malformation. It is essential to emphasize that a thorough understanding of the anatomy of congenital malformations is indispensable to accomplish a successful repair and favorable outcomes in newborns.