Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia

摘要: As more infants with congenital diaphragmatic hernia (CDH) survive by means of extracorporeal membrane oxygenation (ECMO), new clinical observations are being made. We report anatomic and functional abnormalities the esophagus in these infants. Twenty-two 30 CDH survived. Three 7 non-ECMO-treated 14 17 ECMO-treated had an air- or fluidfilled mediastinal mass that was confirmed upper gastrointestinal series as ectatic esophagus. Contrast studies demonstrated severe gastroesophageal reflux. Intra-esophageal pH monitoring significant reflux (Euler scores greater than 50) 69% tested patients. Prolonged acid clearance most patients implied abnormal peristalsis. Hydramnios correlated to observed esophageal abnormalities, present 13 16 available amniotic history. All symptomatic managed without antireflux surgery were discharged 36±2 days after initiation feeding. Follow-up (range: 56 months; mean: 32 months) showed weight gain affected children slower those not affected. but one asymptomatic. Repeat shows persistent ectasia less Gastroesophageal reflux/ectasia is a observation CDH. The associated hydramnios may result from proximal foregut obstruction kinking junction radiographic appearance can be quite unusual. Clinical manifestations manageable account for compromised growth.