TRACHEAL LEFT MAINSTEM BRONCHUS AND OBSTRUCTIVE GASTRIC-MUCOSAL INTUSSUSCEPTION ASSOCIATED WITH ESOPHAGEAL ATRESIA

A tracheal left mainstem bronchus and gastric outlet obstruction owing to gastric mucosal intussusception occurred in a child who had esopha geal atresia and tracheoesophageal fistula. Bronchography and bronchos copy, indicated because of persisting atelectasis and ventilation depe ndency, showed a tracheal left mainstem bronchus. The atelectasis disa ppeared after reimplantation of the left mainstem bronchus into the ca rina. Feeding problems and recurrent pulmonary infections complicated the postoperative course. Radiographic imaging and esophagogastroscopy showed severe reflux esophagitis and a prepyloric mass that consisted of a gastric mucosal intussusception. Subsequent gastrotomy and resec tion of the intussuscepted mucosal fold relieved the gastric outlet ob struction. An antireflux procedure was performed simultaneously. The c hild recovered satisfactorily. It is suggested that gastric mucosal in tussusception may be associated with esophageal atresia rather than wi th the presence of a gastrostomy tube, as has been proposed in the lit erature. Copyright (C) 1995 by W.B. Saunders Company.