Pyloric Stenosis Complicating Esophageal Atresia

Post surgical complications of esophageal atresia (EA) include anastomotic leak, anastomotic stricture, gastroesophageal reflux, tracheomalacia, and recurrent tracheoesophageal fistula (TEF). However, hypertrophic pyloric stenosis (HPS) is complicating EA which seems to be rare. The aim of this report is to emphasize on HPS as a possible complicating post operative course of EA, the diagnosis of this complicating disorder may be delayed. A 3000 gram male infant was born at 38 weeks gestation to a 21-year-old, gravid mother by cesarean section. He presented vomiting with profuse foamy discharge and salivation. Esophageal atresia was confirmed by looped orogastric tube in the upper pouch of esophagus in chest X-ray. He underwent surgical correction and was discharged with a good condition on 7th post operation day. Nevertheless three weeks later, he developed recurrent vomiting. The diagnosis of HPS was confirmed by ultrasonography and barium upper gastrointestinal (GI) series. Pyloromyotomy was done on him and He was discharged without any complication. At 3.5 months old, he developed regurgitation and chocking cyanosis. At this time esophageal stenosis was diagnosed by barium swallow. The stricture was treated by gastroduodenoscopy. Infantile HPS should be considered in any case of persistent vomiting and feeding intolerance after surgery for esophageal atresia. A high index of suspicion is required for diagnosis to avoid complication arising from a delayed diagnosis.