Abstract Ref Number = APCP1022
CHYLOTHORAX AND SEPSIS AFTER PRIMARY REPAIR OF ESOPHAGEAL ATRESIA WITH DISTAL TRACHEOESOPHAGEAL FISTULA A CASE REPORT
Nancy Napitupulu,Yani Damayanthi,Naomi EF Dewanto,Topan B Kitting
Department of NICU Siloam Hospitals Kebon Jeruk Jakarta Indonesia Department of Pediatric Surgery Siloam Hospitals Kebon Jeruk Jakarta Indonesia
Background : Esophageal atresia (EA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the esophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheo-esophageal fistula (TEF). This is a rare case, occurs 1 in 2500 live births. The post-surgical complications in a neonate can be extremely serious.
Case Presentation Summary : A 36 weeker, baby boy born by CS, from G2P1A0 mother, Apgar score 5/7/8, birth weight 2300 g. Atresia esophagus was diagnosed at 8th month pregnancy. The baby was hypersalivated and chest x-ray showed esophageal atresia. Gastrostomy was performed at day 2. At 5 days old, the baby was referred to us and detected 3 mm ostium secundum ASD. Thoracotomy obtained EA with distal TEF so fistule excision and primary anastomosis were performed. Thirteen days post thoracotomy, six days after primary feeding, patient developed respiratory distress. Chest radiograph showed right pleural effusion. WSD revealed cloudy yellow fluid, with the highest production of 1700 ml/day. Pleural fluid analysis was exudate. Esofagogram ensured no anastomotic leakage. Fortieth day of treatment, patient was suffered with sepsis, positive blood culture of Acinetobacter hemolyticus and Stenotrophomonas maltophi. He received several antibiotics for 31 days. The baby fasting for 32 days until fluid production in WSD reduced. He was gradually breastfed. He returned home after 74 days treatment in NICU, exclusively breastfed and weighed 3260 grams.
Learning Points/Discussion : The aim of this case report is to highlight the significance of post EA surgical monitoring and rapidly managing the complications. Incidence of chylothorax after thoracic surgery is between 0.85-6.6%. It is a life-threatening condition which requires immediate diagnostic and treatment. The mortality rate is high without proper management. Treatment can be conservative or surgical. Continuous drainage can lead to malnutrition and infection, that needs permanent monitoring in NICU.
Keywords: Esophageal Atresia Tracheooesophageal Fistula Primary Anastomosis Chylothorax Sepsis