K. Gerlach (Gemeinschaftspraxis für Radiologie/Sangerhausen), Dirk Schaper (Krankenhaus St. Elisabeth und St. Barabara/Klinik für Kinderchirrugie/Halle and der Saale), T. Porrmann (Krankenhaus St. Elisabeth und St. Barabara/Gemeinschaftspraxis für Radiologie/Halle an der Saale)  

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1 Years  

Male  

Thorax-Esophagus  

congenital  

Unremarkable pregnancy, full-term delivery by cesearean section. Postnatal, hypospadia. Up to the time of examination, unremarkable statomotor and mental development. For 8 weeks, increasing postprandial vomiting without weight loss. No diarrhea, no loss of appetite.
Laboratory values at the time of admission were unremarkable. Chest x-ray ruled out pneumonia. ENT consult showed no abnormalities.  

Congenital esophageal stenoses are rarely found. Concurrently, an esophageal atresia, tracheobronchial fistulas or both can be found.
The etiology is unclear.
Histologically, one finds tracheobronchial remnants, fibromuscular - or membranous - stenoses. Even multiple stenoses can be seen. In our case, the histological picture was as follows: fibroepithelial material with covering of squamous epithelial tissue. Proof of hyaline cartilage was found.  

<- view X-Ray 1

X-Ray 1: Esophagus with contrast material: preoperative findings. Prestenotic dilation of the lower esophagus. "Rat tail like" pulling of the poststenotic distal esophagus.






<- view X-Ray 2

X-Ray 2: Esophagus with contrast material: postoperative findings. Scarred changes at the distal esophagus, no significant stenosis. Regression of the prestenotic dilation.


 

Surgery / Histo  

Esophageal stenosis, achalasia of the esophagus  

Suspecting a lower esophageal sphincter achalasia, we chose to surgically intervene. Intraoperatively, there was tight, partially calcified stenosis about 2 cm above the Cardia. A myotomy and resection of the calcified areas was performed. A fundoplication was not performed. Postoperatively, parenteral nutrition and antibiotic prevention. The feeding tube was removed on the 10th postoperative day.
Overall, no complications.

Further treatment options are balloon dilation, bougienage or the surgical-endoscopic resection of the stenosis. Postoperative complications include, but are not limited to, stenoses, hiatal hernias, GERD.  

N/A  

N/A  

Amae S et al.: Clinical characteristics and management of congenital esophageal stenosis: a report of 14 cases. J Pediatr. Surg. 2003 Apr;38(4):565-70
Kawahara H et al.Clinical characteristics of congenital esophageal stenosis distal to associated esophageal atresia. Surgery 2001 Jan;129(1):29-38
Takamizawa S et al.Congenital esophageal stenosis: Therapeutic strategy based on etiology. J Pediatr. Surg. 2002 Feb; 37(2):197-201  

Achalasia of the esophagus, esophageal achalasia, esophageal stenosis, congenital esophageal stenosis, CES, child, childhood, pediatric radiology  

K Gerlach, Dirk Schaper. CES - Congenital Esophageal Stenosis. PedRad [serial online] vol 7, no. 2.
URL: www.PedRad.info/?search=20070220110848