CASE HISTORY

The baby, one of twins, was a full term normal delivery. At birth it was noted to have a hypospadias and an apparently imperforate anus, though in fact the latter proved to be patent after dilation. When fed, the feed was immediately regurgitated and baby became cyanosed and skiagrams after lipiodol showed a blind oesophagus and no gas in the stomach. From the latter point it was assumed that there was no tracheo-oesophageal fistula. The baby was admitted 55 hours after birth. He was in good condition and not dehydrated. Operation done 2 hours after admission. The mediastinum was explored and the gap in the oesophagus was found to be too great to allow an anastomosis. The upper end was, therefore brought out to the skin of the neck but not opened. This blind pouch was aspirated regularly and 36 hours later it was opened and at the same time a gastrostomy was performed. The baby was kept in an oxygen tent and given penicillin, and fed through the gastrostomy. The pouch drained its mucus satisfactorily and the feeds were carefully increased. After four days the child was taken out of the oxygen tent without difficulty and three days later was taking full feeds of expressed breast milk. 24 hours later baby became cyanosed and on the following day developed signs of pneumonia and died the next day in spite of chemotherapy.

PATHOLOGY

The specimen consists of the pharynx, oesophagus and stomach viewed from behind. The pharynx is normal.The upper part of the oesophagus ends in a rather dilated, blind pouch 3cms below the glottis. This pouch had been displaced upwards and outwards through thesternomastoid but it has been replaced in its normal position in the specimen. running down from the left side of this is a fibrous cord about 3.5cm long which opens out into the lower oesophagus which is of normal size, and lay in its normal position. It opens normally into the stomach in which there is a healthy gastrostomy. There is no communication between the oesophagus and trachea. The mass of tissue to the right of the oesophageal pouch is the neck muscles through which it was drawn at operation.