Congenital esophageal stenosis: Pathologic studies following resection

Abstract

1. 1. Congenital esophageal stenosis is not a surgical emergency and is compatible with life, symptoms varying with the severity of the condition. 2. 2. Common symptoms are those of passive regurgitation of ingested material with history of repeated infections of the respiratory tract and poor weight gain. 3. 3. Esophageal stenosis may be web-like consisting of a mucosal diaphragm in the distal third of the esophagus or may be segmental, typically in the middle third of the esophagus, associated with submucosal and muscularis thickening with fibrosis and hypertrophy. 4. 4. Indications for surgical resection include failure to respond to esophageal dilatation, hypertrophy and dilatation of the proximal esophagus with regurgitation and aspiration, repeated infections of the respiratory tract secondary to aspiration, and poor weight gain or malnutrition. 5. 5. The right thoracotomy approach with division of the azygos vein is recommended with resection of the involved segment and end-to-end anastomosis utilizing interrupted non-absorbable sutures. Gastrostomy should be used during the immediate postoperative period for feeding purposes. 6. 6. A case report of segmental congenital esophageal stenosis is included in which surgical treatment was carried out with satisfactory postoperative results. 7. 7. Pathologic examination of the resected tissue revealed submucosal changes of fibrosis and disorganized smooth muscle fibers with normal nerve tissue present.