X-RAY FINDINGS IN THE PEDIATRIC SURGICAL EMERGENCIES

Abstract

The incidence of congenital atresia of the esophagus in generally quoted as 1 in 3, 000 live births. In majority, it is associated with a tracheoesophageal fistula. Prematurity and multiple severe congenital anomalies are the two most common causes of death in these infants.A case of Gross A type atresia of the esophagus associated with high jejunal atresia, jejunal perforation and christmas tree deformity of the distal intestine was presented.The patient, a seven-hour-old girl, was referred to the Department of Surgery, Gunma University Hospital, on March 23, 1974 because of increasing abdominal distention and recurrent cyanotic spells since birth. The up-right scout film of the distended abdomen on admission showed generallized flank opacity without intestinal gas. A Replogle catheter with radiopaque sentinel line was introduced but lodged in the upper third of the esophagus and could not be advanced.Upon entering the peritoneal cavity, a large amount of bilious ascites was gushed out. A markedly distended proximal segment of jejunum ended abruply 5cm. distal to the ligament of Treitz. The remaining small intestine was coiled as an “apple peel” around a narrow mesentery attached at the ileocecal junction. A rupture was found at the apex of the distended proximal blind end of the jejunum. The perforated blind end was resected and end-to-side anastomosis was carried out. A Stamm gastrostomy was performed and a jejunal trans-anastomotic feeding tube was introduced. The abdomen was closed with a tube drainage. Immediately postoperative course was complicated with apneic spells but jejunal tube feeding was started from third p.o.day. She did well thereafter and she weighed about 8Kg. at eight months of age. She is now waiting a definitive operation.