Rare Postoperative Complication of Esophageal Atresia after Open Thoracotomy Repair in Newborn-Lung Torsion: A Case Report

Abstract

In this case report, we described a rare complication-lung torsion after esophageal atresia repair in a newborn. Torsion of the lung is a critical condition in which either the entire lung or a lung lobe twists, leading to occlusion of blood vessels and airways. The patient's clinical condition was poor after the primary operation. An emergency thoracotomy showed 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion, perioperatively, the lung was gradually reperfused and had a normal appearance. After surgery, the patient was unstable, which culminated in a fatal end (bradycardia, reperfusion injury). Immediate intervention can preserve the affected lung or lung lobe. However, pulmonary torsion typically has a poor prognosis due to misdiagnosis and delayed treatment. Additionally, diagnosis in the neonatal period is even more challenging because the clinical symptoms are nonspecific. In any case, the question is whether detorsion is the right solution or whether a segmentectomy is necessary.

Keywords: esophageal atresia; lung torsion; newborn; postoperative complication.

Figure 1

(A)—X-ray-showing the upper end of the esophagus at the level of T4-5, dilated intestinal loops filled with air. (B)—X-ray image taken 2 h post-operation. (C)—X-ray taken 6 days after surgery and after re-drainage of the chest.

Figure 2

CT bronchography—occlusion of the right main bronchus 6 mm distal to the bifurcation, extending 8 mm.

Figure 3

Autopsy finding.

Figure 4

Timeline of case.