Membranous esophageal atresia without tracheoesophageal fistula in a neonate: a rare case report and literature review

Abstract

<title>Abstract</title> Background Membranous esophageal atresia (MEA) without tracheoesophageal fistula (TEF) is a rare form of esophageal atresia (EA). To date, only 13 cases have been reported. We report a case successfully managed by thoracoscopic surgery. To our knowledge, this is the first case treated by this minimally invasive approach. Due to the significant overlap in clinical and radiographic features with Gross type A EA (isolated EA), MEA without TEF is often misdiagnosed. Therefore, we have reviewed the literature and summarized its clinical characteristics to facilitate diagnosis. Case presentation A female neonate presented with frothing, choking, and cyanosis immediately after birth. Nasogastric tube insertion was obstructed at 14 cm from the mouth. Imaging studies confirmed esophageal obstruction and revealed a gasless abdomen. The preoperative diagnosis was suggestive of Gross type A EA. However, intraoperative thoracoscopic exploration revealed preserved esophageal continuity with obstruction caused by an intraluminal membrane. Thoracoscopic longitudinal esophagotomy, membrane resection, and transverse esophagorrhaphy were performed. The postoperative course was uneventful with no evidence of anastomotic leakage or stenosis. At the two-year follow-up, the patient demonstrated age-appropriate growth and development without dysphagia or regurgitation. Conclusions MEA without TEF is an exceedingly rare form of EA. A high index of suspicion is warranted in cases of EA presenting with a long proximal pouch and a gasless abdomen. Thoracoscopic surgery offers a safe, effective, and minimally invasive treatment for this condition.

Affiliated Institutions

• Shanxi Academy of Medical Sciences CN
• Shanxi Provincial Children's Hospital CN

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