Successful management of anastomotic leakage with endoscopic fibrin glue injection after primary repair of pure oesophageal atresia

BMJ Case Rep. 2021 Jan 28;14(1):e238823. doi: 10.1136/bcr-2020-238823.

Abstract

Anastomotic leakage (AL) occurs in 15% of cases of primary repair of oesophageal atresia. Urgent surgery is indicated in cases of complete anastomotic separation or severe mediastinitis. Otherwise, conservative management including keeping the patient nil per os (NPO), feeding via transanastomotic tube and prolonged parenteral nutrition, has been widely accepted as it can avoid multiple surgeries in neonates and allow oesophageal continuity to be preserved. However, complications relating to prolonged feeding tube use are common downsides to this approach and the negative impact of prolonged NPO on mastication and swallowing function cannot be ignored.In this case report, a novel approach for the treatment of AL with fibrin glue is reported, following primary repair of oesophageal atresia. It was endoscopically injected into the leakage site to enhance healing and early closure. This procedure was safely performed and achieved early establishment of oral feeding.

Keywords: endoscopy; interventional radiology; neonatal and paediatric intensive care; paediatric surgery.

Publication types

  • Case Reports

MeSH terms

  • Anastomosis, Surgical
  • Anastomotic Leak / therapy*
  • Down Syndrome / complications
  • Esophageal Atresia / complications
  • Esophageal Atresia / surgery*
  • Esophageal Stenosis / surgery*
  • Esophagoscopy / methods
  • Female
  • Fibrin Tissue Adhesive / therapeutic use*
  • Gastrostomy
  • Humans
  • Infant
  • Infant, Newborn
  • Plastic Surgery Procedures / methods
  • Postoperative Complications / therapy
  • Prenatal Diagnosis
  • Tissue Adhesives / therapeutic use*

Substances

  • Fibrin Tissue Adhesive
  • Tissue Adhesives