Diagnosis and Airway Management in a Neonate with Laryngeal Atresia, Tracheal Agenesis and a Broncho-Esophageal Fistula: A Case Report

Jodi Bosak

doi:10.4172/2155-6148.1000224

Abstract

Tracheal agenesis is a rare congenital anomaly that is usually fatal and occurs in approximately 1:50,000 births. The diagnosis is usually made when there is failure to perform endotracheal intubation in a neonate with severe respiratory distress and absence of audible cry. We present a case of a newborn with suspected trachea-esophageal fistula who presented to the operating room for ligation of the fistula. The diagnosis of laryngeal atresia with tracheal agenesis was made intraoperatively when attempts at surgical ligation of the fistula resulted in difficulty with ventilation and a loss of the capnograph. Ventilation of the lungs was possible with an esophageally placed tube via an esophago-bronchial fistula. This case highlights the importance and need for good communication and teamwork between surgeons, anesthesiologist, radiologist and neonatologists.

Highlights

Tracheal agenesis is a rare congenital anomaly that is usually fatal and occurs in approximately 1:50,000 births with a male: female ratio of 2:1 [1,2]
We have reported a case of a newborn with suspected tracheoesophageal fistula and duodenal atresia that was intraoperatively found to have tracheal agenesis with laryngeal atresia
Since the patient maintained respiratory stability that was commensurate with the comorbidities or coexisting diseases for several days after intubation, confirmation of the endotracheal tube position by direct laryngoscopy was not made in the operating room

Summary

Introduction

Tracheal agenesis is a rare congenital anomaly that is usually fatal and occurs in approximately 1:50,000 births with a male: female ratio of 2:1 [1,2]. The anesthesia and surgical team may face this challenge either at the delivery of the baby or in the operating room [6,7].We present a case of a newborn with laryngeal atresia, tracheal agenesis, and a broncho-esophageal fistula. Reevaluation of the anatomy and direct laryngoscopy in the left lateral decubitus position revealed esophageal placement of the endotracheal tube.

Results

Conclusion