Evaluation of oesophageal atresia without fistula by three-dimensional computed tomography

Abstract.

During the last decade, an increasing number of paediatric surgeons have chosen to perform a delayed oesophageal anastomosis for oesophageal atresia (OA) without tracheo-oesophageal fistula (TOF).The gap between the two oesophageal pouches is an important determinant in the surgical management of these patients. We describe a new method using spiral computed tomography (CT) to evaluate the gap between the proximal and distal oesophageal pouches. In our last four cases of OA without TOF, Stamm gastrostomy was performed soon after birth. At about 4 weeks of age, these patients underwent spiral CT with air inflation via the gastrostomy feeding tube with 3 mm slice thickness, pitch 1, and reconstruction interval every 1.5 mm. A three-dimensional reconstruction was done and measurements of the gap between the two segments were recorded. The procedure was repeated at monthly intervals until the optimal conditions for surgery were observed. All the babies thrived well on gastrostomy feeding. The gap distances were 2.4, 3.8, 4.2 and 5.9 cm respectively. Delayed primary oesophageal anastomosis was accomplished in three cases and gastric transposition was performed in another case at 12, 13, 14 and 16 weeks of age. The exact anatomical position the operation correlated well with the pre-operative three-dimensional CT results. Conclusion: this new technique is an easy and non-invasive method to assess the long gap in babies with oesophageal atresia without tracheo-oesophageal fistula. The radiological findings are also consistent with surgical anatomical situation during surgery suggesting that this investigation is useful in the pre-operative planning of oesophageal anastomosis or replacement.