DOCSLIB.ORG

Lower Oesophageal Web

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lower Oesophageal Web Thorax: first published as 10.1136/thx.22.2.156 on 1 March 1967. Downloaded from Thorax (1967), 22, 156. Lower oesophageal web VIKING OLOV BJORK AND CONSTANTIN G. CHARONIS From the Department of Thoracic Surgery, University Hospital, Uppsala, Sweden A patient with a 'congenital' oesophageal web was suffering from dysphagia and was treated surgically. A review is made of a few similar, well-documented cases. An effort is made to compare the clinical and pathological characteristics of the lesion and to discuss its pathogenesis. The purpose of this paper is to present the case Jutras, Levrier, and Long-tin (1949), Johnstone of a young adult patient who had suffered since (1951), and Evans (1952). birth from dysphagia. The diagnosis of cardio- Ingelfinger and Kramer presented in 1953 six spasm was made during childhood and the lesion patients, each of whom was suffering from sudden was diagnosed recently, and proved at operation, attacks of dysphagia. Radiologically 'the picture to be an annular web involving the mucosa and of a constriction ring-a ring-like band 2 to 6 submucosa, situated 3 cm. above the oesophago- mm. in width-representing a sharply localized gastric junction. lesion with clearly defined margins, situated 2-5 An attempt will be made to correlate the clinical to 6 cm. above the junction of the oesophagus and picture and radiological and pathological findings stomach' was found. Only one of their patientscopyright. of the above well-documented case with others was operated upon, and a resection of the lower reported in the literature. These patients have 4 cm. of the oesophagus was performed. usually had similar presenting symptoms, radio- Schatzki and Gary (1953) reported in the same graphs, and operative findings, but they have had year similar radiological findings in five adult patients complaining of The diameters different clinical histories as well as different dysphagia. http://thorax.bmj.com/ histological findings. These observations suggest of the rings were 3 to 18 mm. and they were tested that this lesion may have several pathogeneses with barium-filled gelatin capsules. Only one (Sweet, 1956; Adams, 1956). patient was operated upon. Although congenital stenosis of the lower Bugden and Delmonico presented in 1956 two oesophagus has always been considered a rarity patients who had lower oesophageal webs and (Beatty, 1928; Guilleminet, 1947; Guilleminet and who complained of dysphagia 'which seemed to Lacour, 1947; Forssner, 1907; Findlay, 1932 ; have been related to the obstructive potential of Malenchini and Resano, 1953), Macmillan (1931, the bolus swallowed'. Both were operated upon. 1935), while reporting the radiological findings in At thoracotomy 'the web was leathery in consis- on September 27, 2021 by guest. Protected a series of 1,600 patients complaining of dys- tency and pliable. The small lumen in both cases phagia, found oesophageal webs in 13% of all (3 and 5 mm. respectively) could barely be felt cases, excluding those in whom foreign bodies with the fingertip. The mucosa above and below were accounting for the dysphagia. the defect felt normal'. Since the original report in 1953 of Ingelfinger In 1958 MacMahon, Schatzki, and Gary re- and Kramer, who first called attention to the ported a well-documented case that had been significance of a web in the lower oesophagus seen followed up for nine years as a classical example radiologically in cases of dysphagia, many of the lower oesophageal ring. The patient came different authors have focused their attention on to necropsy two years after a subtotal gastrectomy this subject. had been performed for a carcinoma of the Webs were described by Templeton in 1944 as antrum of the stomach. The oesophageal ring was a ring-like constriction seen only in the distended found to be covered above by oesophageal state of the oesophagus, a few centimetres above mucosa and below by gastric glands. the diaphragmatic shadow. Templeton emphasized More recently Barrett (1962) reviewed the the importance of distinguishing this from organic problems presented by benign stricture in the stricture. Similar observations were made by lower oesophagus. He concentrated his discussion 156 Thorax: first published as 10.1136/thx.22.2.156 on 1 March 1967. Downloaded from Lower oesophageal web 157 mostly on the topic of pathogenesis of the lesion After doing his military service for a few weeks he after having treated 59 patients who had had was discharged from the Army, since he could not eat benign oesophageal strictures due to reflux. the food served. Barrett resected six benign annular (or ring) The patient's symptoms continued throughout the following years without alteration. During sleep he strictures. He did not present complete data on was obliged to use at least two pillows under his these cases but he stated that 'in every one, head in order to avoid regurgitation. He denied heart- histological preparations proved that there was, burn or loss of weight. below the web, an oesophagus lined by columnar A few months before admission he decided to epithelium, a sliding hiatus hernia, or both'. undergo a complete physical re-examination, though his symptoms were still in statu quo. On admission, physical examination was negative. CASE REPORT He was a well-developed and well-nourished man. He was not ill. Radiographs of the oesophagus showed a sharply B. K., a man aged 28 years, entered the University demarcated circular constriction, as a ring-like band, Hospital of Uppsala on 17 September 1962 com- two fingers' breadth above the cardia. Above the plaining of dysphagia since birth. stricture the oesophagus was a little more than 3 cm. The patient had been a normal full-term baby. in width. Below the stricture the oesophagus was From the very beginning it was impossible for the normal and its contractions were normal (Fig. 1). child to be breast-fed. The baby regurgitated milk, aspirated it, and had attacks of cyanosis. The child was then fed with a teaspoon, and this seemed to be better tolerated. He slowly gained weight and was discharged from hospital four months after birth. At home there was much difficulty in feeding, but dysphagia did not get worse when solid food was given, though it did persist during the following years. The child understood the necessity to eat copyright. slowly and to chew his food well; he knew that laughing or coughing during meals caused a painful 'sticking' sensation under the lower portion of the sternum. He was obliged immediately to drink some water or vomit in order to get relief. Very frequent colds were also noticed. Radio- http://thorax.bmj.com/ graphs of the chest were normal. In October 1945, at the age of 11 years, the patient was admitted to the paediatric department of another hospital for further investigation of his dysphagia. Radiographs of the oesophagus taken at that time showed slight enlargement of the intrathoracic portion with a narrowing at the level of the cardia. The lumen of the oesophagus was estimated to be one finger's breadth at a distance of about 1 in. (25 mm.) on September 27, 2021 by guest. Protected above the diaphragm; the mucosa appeared to be normal. Thick contrast passed down the oesophagus without difficulty. Blood studies were within normal limits. The diagnosis was cardiospasm. Since it was FIG. 1. Pre-operative radiograph demonstrating the possible for the patient to swallow every kind of lower oesophageal web and the dilated oesophagus. food, provided that he ate slowly and chewed it well, and since his weight was good, it was felt that there The passage of the barium was retarded by the was no indication for surgery but that, should the stricture. The radiological diagnosis was 'lower dysphagia get worse, oesophageal dilatations should oesophageal web'. be tried. Oesophagoscopy showed a dilated oesophagus with Radiographs of the oesophagus taken in 1950 (at retention. The oesophagoscope passed into the the age of 16) showed the same findings as previously. stomach and no stricture was seen. The oesophagus was abruptly narrowed one finger's On 18 October 1962, at left thoracotomy, no breadth above the diaphragm. The contrast seemed abnormality could be seen or palpated until the to be mixed with food particles, but there was a oesophagus had been opened. A 3-cm. longitudinal passage to the stomach. No pathological changes incision was made at the predetermined site of were found in the lungs. obstruction. A web-like diaphragm covered on both Thorax: first published as 10.1136/thx.22.2.156 on 1 March 1967. Downloaded from 158 Viking Olov Bjork and Constantin G. Charonis an improvement in comparison with pre-operative pictures was found. The oesophagoscope could easily be passed through the narrowing. Three biopsies 1 cm. below the narrowing demonstrated in one specimen a mucosa completely covered with squamous epithelium, in a second specimen both columnar and squamous epithelium was found, while in a third specimen the columnar epithelium dominated although a small part was covered with squamous epithelium of a meta- plastic type. One centimetre below the narrowing the squamous cell mucosa predominated and beneath it there were fibrosis and chronic inflammatory changes (Fig. 5). DISCUSSION We shall confine our discussion to the well- docu'mented cases reported in the literature. Unfortunately, today, five years after Bugden's statement (1957) that 'the amount of pathologic material available for study of this lesion was negligible', the situation is virtually unaltered. Only one patient of Ingelfinger and Kramer (1953), one of Schatzki and Gary (1953), two of Bugden and Delmonico (1956), and one of FIG. 2. The lesion seen at operation. A longitudinal MacMahon, Schatzki, and Gary (1958) came to incision was made at the predetermined site of the web.
Load more

Recommended publications
  • Esophageal Web Complicating an Isolated Esophageal Lichen Planus
    Bahrain Medical Bulletin, Vol. 40, No. 4, December 2018 Esophageal Web Complicating an Isolated Esophageal Lichen Planus Sara Al-Saad, MB BCh BAO* Abdulla Darwish, FRCPath** Veena Nagaraj, FRCPath*** Zuhal Ghandoor, FRCP**** Lichen planus (LP) is a chronic, idiopathic disorder affecting the mucosal surfaces, skin and nails. Esophageal involvement in this disease is rare and only few cases were found in literature, thus making its diagnosis challenging as it can be easily misdiagnosed as gastroesophageal reflux disease. Currently, little is known about its pathogenesis and management. We report a case of a previously healthy 32-year-old female who presented with the complaint of dysphagia, which was later diagnosed endoscopically as an esophageal web. Biopsy of the lesion revealed a histological diagnosis of an esophageal lichen planus (ELP). This was treated with multiple Esophagogastro Duodenoscopy (OGD) dilatation sessions and local steroids. We also reviewed similar reported cases in the literature, stressing on the importance of the successful management of such a disease and its complications. Bahrain Med Bull 2018; 40(4): 254 - 256 Lichen Planus (LP) is a mucocutaneous disease of the stratified The treatment of esophageal webs includes endoscopic squamous epithelium, which affects the mucous membranes, dilatation, steroids and surgical myomectomy3. skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. It is mostly reported in middle- The relationship between ELP and esophageal webs is not clear aged patients (between 30-60 years of age) and is seen more and rarely reported in the literature. evidently in females1. The aim of this presentation is to report a case of esophageal It is one of the chronic disorders where oral involvement may web complicating an ELP.
    [Show full text]
  • Hypertrophic Pyloric Stenosis
    Imaging of Pediatric Abdominal Disease Mark S. Finkelstein DO, FAOCR Department of Medical Imaging What is our goal? . Familiarize pediatricians to a variety of common pediatric GI disorders . Outline a practical approach to imaging pediatric GI diseases . Review current methods & discuss current imaging techniques for the evaluation of pediatric GI disease What is the purpose of the plain film abdomen study? . Foundation of GI imaging . Distinguishes surgical vs. non-surgical disease . Considerations – AP supine: . Used to evaluate vague or chronic abdominal pain – Horizontal beam: . Used to demonstrate free intra-peritoneal air (erect,supine cross table lateral or decubitus) – Prone: . Useful for differentiating large from small bowel . Useful for excluding SBO Common Imaging Techniques . Fluoroscopy . Ultrasound . CT . Nuclear Medicine . MRI Fluoroscopy Technique . Fasting time: – Premature = 2-4 hours NPO – Infant < 2 1/2 yrs = 4 hours NPO – Children > 2 1/2 yrs = 6 hours NPO . Digital low dose fluoroscopy with small field size . Contrast medium: – Barium is best – Air – Other options: . Gastrograffin (GG) = High osmolality, water soluble warning: GG should only be used by qualified experienced pediatric radiologists . Metrizimide, Iohexol, Iopamidol, etc.= low osmolality, non-ionic water soluble Ultrasound Technique . Abdomen Prep (Complete/Limited) Fasting time: – Children < 5 yr. = 4 hours NPO – Children > 5 yr. = 8 hours NPO . Renal/Pelvic Prep – Infant < 1 yr. = Patient given formula, juice during exam – 1yr- 10yrs = Child must drink 12-16 oz clear fluid 1 -2 hrs prior to exam – > 11 yr. = Child must drink 24-32 oz clear fluid 1 -2 hrs prior to exam Children who are continent should not empty bladder 3 hrs prior to renal US exam CT Technique .
    [Show full text]
  • Habilitative Services and Outpatient Rehabilitation Therapy
    UnitedHealthcare® Commercial Coverage Determination Guideline Habilitative Services and Outpatient Rehabilitation Therapy Guideline Number: CDG.026.11 Effective Date: May 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ........................................................................... 1 • Cochlear Implants Definitions ........................................................................................... 6 • Cognitive Rehabilitation Applicable Codes .............................................................................. 9 • Durable Medical Equipment, Orthotics, Medical References .......................................................................................36 Supplies and Repairs/ Replacements Guideline History/Revision Information .......................................36 • Inpatient Pediatric Feeding Programs Instructions for Use .........................................................................36 • Skilled Care and Custodial Care Services Medicare Advantage Coverage Summaries • Rehabilitation: Cardiac Rehabilitation Services (Outpatient) • Rehabilitation: Medical Rehabilitation (OT, PT and ST, including Cognitive Rehabilitation) • Respiratory Therapy, Pulmonary Rehabilitation and Pulmonary Services Coverage Rationale Indications for Coverage Habilitative Services Habilitative services are Medically Necessary, Skilled Care services that are part of a prescribed treatment plan or maintenance program* to help a person with a disabling condition to
    [Show full text]
  • Clinical Vignette Abstracts NASPGHAN Annual Meeting October 10-12, 2013
    Clinical Vignette Abstracts NASPGHAN Annual Meeting October 10-12, 2013 Poster Session I Eosphagus Stomach 11 Successful Use of Biliary Ducts Balloon Dilator in Repairing Post-Surgical Esophageal Stricture in premature infant. I. Absah, Department of Pediatirc Gastroenterology and Hepatology, Mayo Clinic college of Medicien, Rochester, Minnesota, UNITED STATES. Absah, M.B. Beg, Department of Pediatirc Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, New York, UNITED STATES. Background: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common type of gastrointestinal atresia with occurrence rate of I in 3,000 to 5,000 births. There are 5 major varieties of EA. The most common variant of this anomaly consists of a blind esophageal pouch with a fistula between the trachea and the distal esophagus, which occurs in 84% of the time. Treatment is by extra-pleural surgical repair of the esophageal atresia and closure of the tracheoesophageal fistula. Complications may include leakage to the mediastinum, fistula recurrence, GERD, and stricture formation at the anastomosis site. Benign stricture occurs in 40% of the cases after surgical repair. These benign post-surgical strictures cause feeding difficulties and require treatment. Esophageal dilation is 90% effective, but strictures that do not respond to dilation must be resected surgically. Case report: A 52 days old premature baby that was born at 35 weeks presented with feeding difficulty, due to benign esophageal stricture 44 days after surgical repair of EA and TEF. The luminal diameter of the stricture was ≤ 4mm, for that regular balloon esophageal dilators (smallest = 6mm) couldn’t be used.
    [Show full text]
  • Esophageal Web in a Down Syndrome Infant—A Rare Case Report
    children Case Report Esophageal Web in a Down Syndrome Infant—A Rare Case Report Nirmala Thomas 1, Roy J. Mukkada 2, Muhammed Jasim Abdul Jalal 3,* and Nisha Narayanankutty 3 1 Department of Pediatrics, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] 2 Department of Gastromedicine, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] 3 Department of Family Medicine, VPS Lakeshore Hospital, 682040 Kochi, Kerala, India; [email protected] * Correspondence: [email protected]; Tel.: +91-954-402-0621 Received: 8 November 2017; Accepted: 8 January 2018; Published: 11 January 2018 Abstract: We describe the rare case of an infant with trisomy 21 who presented with recurrent vomiting and aspiration pneumonia and a failure to thrive. Infants with Down’s syndrome have been known to have various problems in the gastrointestinal tract. In the esophagus, what have been described are dysmotility, gastroesophageal reflux and strictures. This infant on evaluation was found to have an esophageal web and simple endoscopic dilatation relieved the infant of her symptoms. No similar case has been reported in literature. Keywords: trisomy 21; recurrent vomiting; aspiration pneumonia; esophageal web 1. Introduction In 1866, John Langdon Down described the physical manifestations of the disorder that would later bear his name [1]. Jerome Lejeune demonstrated its association with chromosome 21 in 1959 [1]. It is the most common chromosomal abnormality occurring in humans and it is caused by the presence a third copy of chromosome 21 (trisomy 21). It is associated with multisystem involvement with manifestations that grossly impact the quality of life of the child.
    [Show full text]
  • Clinical Vignette Abstracts Thursday October 21, 2010 1 ESOPHAGEAL
    Clinical Vignette Abstracts Thursday October 21, 2010 1 ESOPHAGEAL INFLAMMATION WITH EOSINOPHILIC INFILTRATION IN CHRONIC GRANULOMATOUS DISEASE B. Kessler, Pediatrics, Good Samaritan Hospital Medical Center, West Islip, NY; S. Schuval, Pediatrics, Schneider Children's Hospital, New Hyde Park, NY Chronic granulomatous disease(CGD)is a primary immunodeficiency disorder of phagocytic oxidative metabolism. Gastrointestinal involvement is common in CGD especially if the inheritance is x‐linked. Colonic disease is the most common area of involvement. Esophageal disease including stricture formation and dymotility, while reported is less common. Few studies have described the histopathology in CGD‐associated esophageal disease but nonspecific inflammation or granuloma formation has beem seen. We report a 16 month old male diagnosed with X‐linked CGD at age 1 month who presented at 16 months with rectal bleeding, abdominal pain and anemia. There was no previous history of vomiting,regurgitation or feeding difficulties. Past history was significant for rectal bleeding at age 10 days while receiving cow's milk‐ based formula and breast milk. The bleeding resolved with substitution of a hydrolyzed cow's milk‐based formula, although breastfeeding without maternal milk avoidance continued. Colonoscopy and upper endoscopy were performed at 16 months. Biopsies of the colon revealed inflammation only of the right side i.e. acute cryptitis and colitis without granuloma. Biopsies of the duodenum and stomach were normal. Esophageal biopsies revealed active esophagitis with 20 eosinophils per HPF and neutrophilic infiltrate without granuloma. GMS and PAS stains were negative for bacteria or fungi. Endoscopic appearance of the distal esophagus demonstrated scattered white plaques. Testing for serum specific IgE antibodies only demonstrated a class II response to beta lactoglobulin.
    [Show full text]
  • ICD-10-CM Coding for Birth Defects, Part 2
    Transition to Use of ICD-10-CM Coding for Birth Defects, Part 2 Janet Cragan, MD, MPH NBDPN Guidelines and Standards Committee April 15, 2014 National Center on Birth Defects and Developmental Disabilities Division of Birth Defects and Developmental Disabilities Implementation of ICD-10-CM/PCS Protecting Access to Medicare Act of 2014 “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.” The National Center on Health Statistics and the Centers for Medicare & Medicaid Services are working to identify a new implementation date. NBDPN strongly recommends that birth defects programs take advantage of the delay to continue development, revision, and implementation of their plans to transition to use of ICD-10-CM/PCS. 2 ICD-10-CM Coding Structure of codes Addition of new codes for increased specificity . Ability to code and retrieve more individual diagnoses Incorporation of new characteristics into the codes . Laterality . Timing of examination . Birth order of infant in multiple gestations A few areas with decreased specificity Reorganization of codes within organ systems Conditions moved to different areas of the code NBDPN code translation tools 3 Code Structure in ICD-10-CM Codes can be 3 to 7 characters long . All have the potential to contain 7 characters 1st character – Always alphabetic . A – T, V, Z 2nd character – Always numeric 3rd-7th characters – Either alphabetic or numeric The last character can take on a variety of specified meanings for different codes Use of dummy placeholder “X” for characters without values 4 Changes in ICD-10-CM Coding Use of last character for specific meaning (code O09.0) .
    [Show full text]
  • Figure Credits
    Figure Credits Aarskog, D., Diagrams III, IV DeFraitcs, F., 427A Abrams, A., 4 7 5 DeMycr, W., 290, 340, Tables XVI-XX Agatston, H.J., 33 Dental Clinics of North America Allderdice, P.W., 177 475 19o27, 1975 American Journal of Diseases of Children(© AMA) Desnick, R.J., Diagram VII 151 105o588, 1963 Dieker, H., 328, 329 267 123o254, 1972 Dorst, J.P., 296, 298 455 107o49, 1964 Doyle, P.J., 319 American Journal of Human Genetics (U. of Chicago Press) Drescher, E., 272, 273 175 19o586, 1967 Drews, R., 53,54 177 20o500, 1969 Duhamel, B., 126 Annates de Genetique Durand, P., 268 169 !Oo221, 1967 Ea<;tman Kodak©, 109 170 7o17, 1964 F.lsahy, N.L, 150 Annales de Radiologic English, G.M., 318 453 16o19, 1973 Epstein, C.J., 496 Annates Paediatrici (Basel) Ev,ns, P.Y., 6, ll-13, 15, 17, 18, 22, 27, 28, 31, 32, 43, 45-47, 204 199o393, 1962 55, 59, 61, 65, 71, 75, 76, 92,95 Annals of Internal Medicine Excerpta Medica International Congress Series No. 55, Proc. XII 449-452 84(4)o393, 1976 Int. Cong. Derm. Archives of Dermatology (© AMA) 112 p.331,1962 295 101o669, 1970 Feingold, M., 67, 73, 74, 97, 207 Archives of Neurology (© AMA) Ferguson-Smith, M.A., 98, 493 8o318, 1963 143 Forsius, H., 444 Armstrong, H. B., 188 Franceschetti, A.T., 259-261 Aurbach, G.D., 433,434 Francke, U., 173 Ayerst Laboratory, 1, 7, 16, 25, 26, 29, 30, 33, 35, 36, 40 42, 52 Fran<;ois, J., 127 Baller, F., 208 Fraser, F.C., 24 7 Bannerman, R.M., 463 Fraser, G.R., 215 Bart, B.J., 246,425 (left), 501 Bartsocas, C.S., 391 Fraumeni, J.F., Jr., 288 Beaudet, A., Jr., 196 Frenkel, J.K.,
    [Show full text]
  • Esophageal Strictures and Webs
    Esophageal Strictures and Webs Background Esophageal strictures typically refer to intrinsic esophageal disease processes causing luminal narrowing. The two main categories are benign (most common) and malignant strictures. Benign strictures: Peptic strictures account for 70-80% of benign strictures and occur within 4 cm of the squamocolumnar junction in the distal esophagus and progressive dysphagia to solids is the most common presenting symptom. Other common benign strictures include esophageal webs and rings. An esophageal web is a thin (<2 mm) eccentric membrane that is commonly located in the anterior cervical esophagus in the postcricoid region. Webs are identified in approximately 5-15% of patients with dysphagia undergoing barium esophagram and are also more prevalent in females. Despite the association of esophageal webs with iron deficiency anemia (Plummer-Vinson syndrome), there is no correlation between the two entities and webs are not necessarily improved with iron therapy. Esophageal webs can also be associated with other conditions such as chronic graft-versus-host disease (due to accretion of desquamate esophageal epithelium), pemphigoid, epidermolysis bullosa, psoriasis and Stevens-Johnson syndrome. Although most patients with esophageal webs are asymptomatic, long-standing dysphagia to solids is the most common presentation in symptomatic patients. An esophageal ring is a concentric (0.2-0.5 cm) tissue that is commonly seen in the distal esophagus. Smith, MS. divided esophageal rings into three groups. “A” rings are located approximately 1.5 cm proximal to the squamocolumnar (esophagogastric) junction and are caused by normal physiologic smooth muscle contraction. They are rarely symptomatic. “B” rings, also referred to as a Schatzki ring, are located at the squamocolumnar junction and are the most common type of esophageal ring.
    [Show full text]
  • Embryogenesis of Esophageal Atresia: Is Localized Vascular Accident a Factor?
    Case Report Full text online at http://www.jiaps.com Embryogenesis of esophageal atresia: Is localized vascular accident a factor? Hemonta K. Dutta, Shree Harsh Department of Pediatric surgery, Assam Medical college, Dibrugarh, Assam, India Address for correspondence: Dr. Hemonta K. Dutta, Assam Medical College & Hospital, Dibrugarh, Assam-786 002, India. E-mail: [email protected] ABSTRACT Several theories on embryogenesis of esophageal atresia have been proposed, none could explain the whole spectrum of this anomaly. We report a new variant of esophageal atresia in which the two blind pouches were joined by an atretic band. Histology of the atretic part showed groups of striated muscle arranged haphazardly without any lumen. The existing theories on etiology of esophageal atresia cannot explain this variant. However, localized vascular accident during intrauterine life resulting in disturbances in regional microcirculation could be a possible factor as demonstrated by Louw and Barnard in relation to jejunoileal atresia. This is contrary to the current understanding that disproportionate growth of the horizontal esophageal folds results in esophageal atresia. KEY WORDS: Embryogenesis, esophageal atresia DOI: 10.4103/0971-9261.55158 INTRODUCTION joined by an atretic segment about 24 mm long and two mm thick [Figures 1 and 2]. The segment seemed to have The embryogenesis of esophageal atresia (EA) is a few muscle fibers [Figure 3]. The atretic segment was poorly understood. Theories such as intra embryonic excised, blind ends opened and a primary anastomosis pressure, vascular accidents, failure of recanalization, performed. The patient had an uneventful recovery and disproportionate growth of the lateral epithelial folds was discharged on 12th post operative day.
    [Show full text]
  • 7.1 Birth Defects Code List
    7.1 BIRTH DEFECTS CODE LIST Based on the British Pediatric Association (BPA) Classification of Diseases (1979) and the World Health Organization's International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) (1979) Code modifications developed by Division of Birth Defects and Developmental Disabilities National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Public Health Service U.S. Department of Health and Human Services Atlanta, Georgia 30333 and Birth Defects Epidemiology and Surveillance Branch Epidemiology and Disease Surveillance Unit Texas Department of State Health Services 1100 West 49th Street Austin, TX 78756 Revised July 31, 2019 TABLE OF CONTENTS Table of Contents .................................................................................................................................................. 2 Introduction To Birth Defect Diagnosis Coding ................................................................................................. 7 Purpose ............................................................................................................................................................ 7 BPA coding system .......................................................................................................................................... 7 Description of the BPA code ............................................................................................................................ 8 Problems with the
    [Show full text]
  • Guidelines for Conducting Birth Defects Surveillance
    NATIONAL BIRTH DEFECTS PREVENTION NETWORK HTTP://WWW.NBDPN.ORG Guidelines for Conducting Birth Defects Surveillance Edited By Lowell E. Sever, Ph.D. June 2004 Support for development, production, and distribution of these guidelines was provided by the Birth Defects State Research Partnerships Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention Copies of Guidelines for Conducting Birth Defects Surveillance can be viewed or downloaded from the NBDPN website at http://www.nbdpn.org/bdsurveillance.html. Comments and suggestions on this document are welcome. Submit comments to the Surveillance Guidelines and Standards Committee via e-mail at [email protected]. You may also contact a member of the NBDPN Executive Committee by accessing http://www.nbdpn.org and then selecting Network Officers and Committees. Suggested citation according to format of Uniform Requirements for Manuscripts ∗ Submitted to Biomedical Journals:∗ National Birth Defects Prevention Network (NBDPN). Guidelines for Conducting Birth Defects Surveillance. Sever, LE, ed. Atlanta, GA: National Birth Defects Prevention Network, Inc., June 2004. National Birth Defects Prevention Network, Inc. Web site: http://www.nbdpn.org E-mail: [email protected] ∗International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Ann Intern Med 1988;108:258-265. We gratefully acknowledge the following individuals and organizations who contributed to developing, writing, editing, and producing this document. NBDPN SURVEILLANCE GUIDELINES AND STANDARDS COMMITTEE STEERING GROUP Carol Stanton, Committee Chair (CO) Larry Edmonds (CDC) F. John Meaney (AZ) Glenn Copeland (MI) Lisa Miller-Schalick (MA) Peter Langlois (TX) Leslie O’Leary (CDC) Cara Mai (CDC) EDITOR Lowell E.
    [Show full text]