Tracheobronchial Remnants |
| Tracheobronchial
remnants (TBR) are a rare but consistent cause of congenital esophageal
stenosis in newborns and infants. The stenosis occurs in the lower
esophagus (distal third). TBR anomalies including the cartilaginous
rest sometimes present are viewed as different manifestations of a
spectrum of abnormal embryonic separation of the foregut from the
respiratory tract occurring during the 25th day of gestation.
Histologically, the TBR includes cartilage, early columnar metaplasia,
disorganized/hyperplastic muscular layer and ectopic glandular tissue.
The most common association in children with TBR is the presence of
concomitant esophageal atresia a/o tracheoesophageal fistula. The
differential diagnosis includes peptic acid esophageal stricture due to
gastroesophageal reflux. Symptoms start in early infancy includes
progressive dysphagia and vomiting of solid food, food impaction,
stridor, repeated respiratory infection, and failure to thrive.
Esophagogram shows a narrow stricture in the lower esophagus with
proximal dilatation. The mucosa is normal during endoscopy with biopsy.
Esophageal dilatation is not very effective and carries a high risk of
perforation and leakage. Surgical resection of the stenotic segment
with end-to-end anastomosis is the treatment of choice. Resection can
be performed through either laparotomy or thoracotomy depending on the
location of the lesion. An antireflux operation concomitant with the
resection of the remnant will help prevent gastroesophageal reflux in
children with a narrowing near the esophagogastric junction. References: 1- Yeung CK, Spitz L, Brereton RJ, Kiely EM, Leake J: Congenital esophageal stenosis due to tracheobronchial remnants: a rare but important association with esophageal atresia. J Pediatr Surg. 27(7):852-5, 2992 2- Olguner M, Ozdemir T, Akgür FM, Aktuğ T: Congenital esophageal stenosis owing to tracheobronchial remnants: a case report. J Pediatr Surg. 32(10):1485-7, 1997 3- Dutta HK, Mathur M, Bhatnagar V: A histopathological study of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 35(3):438-41, 2000 4- Kawahara H, Imura K, Yagi M, Kubota A: Clinical characteristics of congenital esophageal stenosis distal to associated esophageal atresia. Surgery. 129(1):29-38, 2001 5- Vasudevan SA, Kerendi F, Lee H, Ricketts RR: Management of congenital esophageal stenosis. J Pediatr Surg. 37(7):1024-6, 2002 6- Amae S, Nio M, Kamiyama T, Ishii T, Yoshida S, Hayashi Y, Ohi R: Clinical characteristics and management of congenital esophageal stenosis: a report on 14 cases. J Pediatr Surg. 38(4):565-70, 2003 |
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