Combined esophageal atresia (EA), tracheoesophageal fistula (TEF) and duodenal obstruction result in various challenges in management, and a well-defined management protocol is still lacking. Esophageal stricture is the most common complication after EA repair. The use of magnetic compression alimentary tract anastomosis has been reported in children. By searching the literature, the present study reports the first case of simultaneous repair (EA repair followed by duodenal obstruction repair) and magnetic compression stricturoplasty for refractory esophageal stricture after EA repair in two male neonates. One of the neonates received delayed treatment of duodenal obstruction, and the other successfully underwent a simultaneous emergency operation of these combined anomalies. These two infants developed refractory strictures despite multiple endoscopic dilatation procedures during the postoperative follow-up period. Magnetic compression stricturoplasty procedures were successfully performed under fluoroscopic and endoscopic guidance without any leakage or complication. At the follow-up 10-months after stricturoplasty, the two patients achieved durable esophageal patency in the absence of dysphagia. Combination of early chest and abdominal X-ray detection is recommended to avoid a delayed diagnosis and treatment, as well as the synchronous operation for EA/TEF repair and duodenoduodenostomy in a single surgery for combined EA/TEF and duodenal obstructions. Therefore, magnetic compression stricturoplasty is a feasible and efficient method for establishing early patency of the esophagus in patients with refractory EA stricture.
Keywords: duodenal obstruction; esophageal atresia; esophageal stricture; interventional endoscopy; magnetic compression anastomosis; tracheoesophageal fistula.
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