Question: Hi Doctors,

I am reaching out to this elite group to know treatment options for my daughter (1 year 8 months old) who has undergone a corrective surgery for long gap EA recently and currently suffering from anastomotic stricture.

My daughter was born on 01-Jun-2014 and was diagnosed with Long gap EA soon after birth. On day 2 of birth surgeons here performed Gastrostomy and Esophagostomy.

On 21-July-2015 she underwent a surgery which was planned for gastric pull-up, however surgeons discovered that her lower esophageal pouch had grown significantly and decided that it was appropriate to retain the native esophagus. Thus the surgery was performed to join the two ends of the esophagus.
8 days post operation contrast study revealed that the anastomosis site had a major leak, ICD tube was placed and the leak was allowed to drain and heal on its own, with nil oral feeds and antibiotics. Feeds were given through Jejunostomy.

2 months later the leak gradually reduced to nil, and 6 weeks later the ICD tube (placed at upper right side of the chest) was removed post ultrasound & chest x-ray revealed no collection.
We started feeds orally and she accepted well except for a high degree of reflux. Periodic endoscopic balloon dilations were performed, in an interval of 2-3 weeks for treating the anastomotic stricture. As of 02-Jan-2016, 8 dilations have been performed.

Post last dilation, on 19-Dec-2015, she developed constant fever which persisted for 5 days, followed by leak at ICD wound. ICD tube has been reinserted at the same location as before and saliva leaking from anastomosis site continues to drain out.

Our Gastroenterologist (who performed the dilation) thinks the leak might have happened due to the recent dilation which might have caused the healed anastomotic site to be loosened / weakened and a part of the weak portion has given away. He has asked us to wait for the leak to stop and concentrate on her nutrition through JJ tube, as there are no other better options at this moment. The leak seems to have come down since past 2 weeks and is currently at 3-5 ml per day (24 hours).

We are seeking clarifications and way forward on below queries:

1. Current chest tube drain is 3-5 ml/day and is pale yellow (sometimes milkish cloudy) in colour, is this normal? We give her beetroot juice, papaya, mashed rice ganji etc, and not seen any food particles (or similar colouration) in the chest drain fluid.

2. She does not consume semi solid food (or not so well mashed foods), seems like the anastomotic stricture has narrowed! Dilation which was carried out till now is a painful repeatative procedure, is there an better alternative to this (stents etc.)?

Any references or point of contact in this regard is very helpful!

Thanks in advance for your time.