Tracheal compression by the stomach following gastric transposition in a toddler

Abstract

Gastric transposition is widely employed for esophageal replacement. However, postoperative respiratory failure is one of the most fatal complications of this procedure, and its exact cause remains unclear. A 1-year-old boy with VATER association underwent retrosternal gastric transposition for a long-gap esophageal atresia. The patient experienced respiratory failure immediately after surgery. Bronchoscopy and computed tomography revealed tracheomalacia due to tracheal compression from the gastric pull-up. Extubation became difficult, and tracheostomy was performed. Intermittent decompression using a nasogastric tube, tracheostomy, and high positive end-expiratory pressure ventilation were continued until the tracheal lumen was no longer collapsed. The frequency of dyspnea gradually decreased, and the patient's transition to home medical care was possible at the age of two years. This case highlights the need to consider the effects of tracheomalacia after gastric transposition. Reconstruction through a retrosternal route may make subsequent vascular and tracheal procedures for the correction of tracheomalacia more challenging. If a posterior sternal route must be chosen because of the extensive mediastinal adhesions, it may be necessary to use a relatively small-capacity esophageal reconstruction organ, such as the large intestine, or to perform volume reduction surgery of a lifted stomach.

Keywords

• Gastric transposition
• Esophageal replacement
• Tracheomalacia