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Case Reports
. 2015 Apr 23;2015(4):rjv048.
doi: 10.1093/jscr/rjv048.

Restoring esophageal continuity following a failed colonic interposition for long-gap esophageal atresia

Beatrice Dionigi  1 , Sigrid Bairdain  2 , Charles Jason Smithers  3 , Russell W Jennings  3 , Thomas E Hamilton  3
Affiliations
Case Reports

Restoring esophageal continuity following a failed colonic interposition for long-gap esophageal atresia

Beatrice Dionigi et al. J Surg Case Rep. .

Abstract

The Foker process is a method of esophageal lengthening through axial tension-induced growth, allowing for subsequent primary reconstruction of the esophagus in esophageal atresia (EA). In this unique case, the Foker process was used to grow the remaining esophageal segment long enough to attain esophageal continuity following failed colonic interpositions for long-gap esophageal atresia (LGEA). Initially developed for the treatment of LGEA in neonates, this case demonstrates that (i) an active esophageal lengthening response may still be present beyond the neonate time-period; and, (ii) the Foker process can be used to restore esophageal continuity following a failed colonic interposition if the lower esophageal segment is still present.

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Figures

Figure 1:
Figure 1:
(A) Lateral view during her initial fluoroscopic examination illustrating a small, distal (lower) esophageal remnant present in situ (Black arrows). Contrast was injected through her existing gastrostomy tube. (B) Anterior–posterior (AP) view during initial fluoroscopic examination illustrating an aperistaltic, native colonic interposition in situ with significant dilatation.
Figure 2:
Figure 2:
Fluoroscopic examination illustrating incremental ‘growth’ of the distal (lower) esophageal segment while the patient was undergoing external traction (Foker Stage 1). The contrast was injected through her existing gastrostomy tube. The metal dot refers to her esophagostomy; thus, can measure the distance between the ends of her esophageal segments.
Figure 3:
Figure 3:
An intraoperative esophagram following a routine esophagogastroduodenoscopy (EGD) is pictured on the right, as compared with her postoperative esophagram on the left. The EGD was performed on this patient following her anastomosis (Foker Stage II); the native esophagus was now in continuity. Contrast was injected above the level of the anastomosis, which demonstrated neither leak nor stricture.
Figure 4:
Figure 4:
Her last follow-up EGD demonstrating a patent native esophagus.
See this image and copyright information in PMC

References

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