Kluth Type IIIb6 Esophageal Atresia: Diagnostic Dilemma and Pitfalls of Using Infant Feeding Tube

Abstract

We describe three male neonates where infant feeding tube (IFT) passed 18-20 cm in the upper esophageal pouch. A blunt-tipped red rubber catheter confirmed esophageal atresia (EA) with long upper pouch in all three cases. Definitive management revealed EA with tracheoesophageal fistula and long overlapping upper esophageal pouch consistent with Kluth Type IIIb₆ variant in two patients. Importance of using red rubber catheter at the pediatric practice instead of IFT is stressed.

Keywords: Esophageal atresia; Kluth Type IIIb6; long overlapping upper pouch; red rubber catheter.

Figure 1

Preoperative chest radiographs (anteroposterior and lateral views; left upper) showing red rubber catheter in the esophagus arrested at the T8 vertebral level (red arrow) with the presence of gas in the abdomen; esophagogram without catheter in situ (left lower) showing dilated, upper pouch (red arrow) at higher level; operative pictures (right lower) showing dilated, long, colon-like upper pouch (white arrow) overlapping with distal fistula (blue arrow) and fibromuscular strands (yellow arrow) between the two (black arrow-overlying pleura); diagrammatic representation (right upper) of Kluth Type IIIb₆ variant with fibromuscular strands between both pouches

Figure 2

Diagrammatic representation (right) of Kluth Type IIIb₆ variant; intraoperative picture (right upper) showing long upper esophageal pouch overlapping distal tracheoesophageal fistula (white arrow); preoperative radiograph (inset image) showing red rubber catheter in the esophagus arrested at the T6/T7 vertebral level (red arrow)