Lung torsion after tracheoesophageal fistula repair in an infant

Abstract

Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

Keywords: Complications; Lung; Torsion; Tracheoesophageal fistula.

Fig. 1

Chest radiographs showing (A) opacification of the right upper lobe on the first postoperative day; (B) rapidly progressing consolidation with volume expansion of the right hemithorax on the second postoperative day; and (C) opacification of the right lung at follow-up at 6 months of age.

Fig. 2

Computed tomographic scans showing (A) abrupt narrowing of the right upper lobar bronchus (arrow) and no visible right middle lobar bronchus with extensive consolidation on the second postoperative day and (B) persistent consolidation of the right middle lobe on the seventh day after reoperation.

Fig. 3

Intraoperative pictures showing 180° torsion of the right upper lobe (white arrow) and right middle lobe (black arrow, clockwise). After detorsion of both the lobes, some color change of the right upper lobe observed but the color change in the right middle lobe was undetermined.