Patient Case Discussion
Case Summary
Esophageal Atresia and Tetralogy of Fallot
The team discussed a case of a patient with esophageal atresia and tetralogy of Fallot. The patient underwent three operations: bronchoscopy, ligation of the tracheoesophageal fistula, and repair of the tetralogy of Fallot. The decision to prioritize the ligation of the tracheoesophageal fistula over the esophageal anastomosis was made because of concerns about the patient's cardiac condition and the potential for complications. The team emphasized the importance of multidisciplinary collaboration and the need to prioritize the patient's survival in the first week. The decision to avoid a more invasive procedure, such as thoracoscopy, was also discussed, with the team valuing the opinions of their colleagues and prioritizing the patient's physiological reserve.
Radiograph Analysis and Sacral Anomalies
A radiograph of a baby was discussed, focusing on the presence of a tube in the upper part of the neck and gas within the bowel loops. The findings were indicative of oesophageal atresia with a tracheo-oesophageal fistula. The team noted the absence of vertebral bodies at T11 and abnormal sacral bone configuration, which suggested significant sacral anomalies. The team emphasized the usefulness of the baby gram, which provides a comprehensive view of the patient's torso, aiding in the correlation of findings and diagnosis.
Complex Esophageal Atresia Surgical Case
A complex surgical case was discussed that involved a child with esophageal atresia and a fistula. The child underwent a cardiac repair and then a second surgery to repair the esophageal atresia. The second surgery was challenging Because of adhesions and a plural tear, which led to a prolonged search for the previously placed clips. The child was extubated in the operating room due to clotting of the endotracheal tube. The surgical team decided to approach the chest from the left side for both surgeries to avoid additional morbidity. Dr. Lebert, an expert in esophageal atresia, confirmed that the procedures were done well.
Cardiac Anomaly and Tracheoesophageal Fistula
A patient with a cardiac anomaly and a tracheoesophageal fistula was discussed. The decision was made not to repair the fistula, based on the patient's hemodynamic status and cardiac anomaly. The team clipped the fistula without dividing it to minimize complications. A gastrostomy was also placed. The team considered the patient's weight issue but concluded it was not a significant factor in their decision. The use of a chest X-ray and echo to assess the arch and descending aorta was discussed, with the echo being particularly useful. A bronchoscopy was performed to assess the fistulas and vocal cords. The importance of understanding the aorta's crossing point during surgery was emphasized.