Polymer Surgical Clip Migration Into the Trachea of an Infant

Thomas M. Hagopian, BA, Paula J. Harmon, MD, Matthew S. Clifton, MD

Emory University School of Medicine, Atlanta, GA, USA (Hagopian). Division of Pediatric Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA (Dr. Harmon). Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA (Dr. Clifton).

ABSTRACT

Introduction: Newborns with congenital esophageal atresia and a distal tracheoesophageal fistula undergo repair by several different approaches, the newest of which is thoracoscopic. The fistula is frequently occluded using a small polymer or titanium clip at the point of insertion into the trachea.

Case Description: We report the case of a 1-day-old male newborn with proximal esophageal atresia and a distal tracheoesophageal fistula who underwent thoracoscopic repair and who then presented with respiratory distress 10 weeks later. The polymer Hem-o-lok clip (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) used to ligate the tracheoesophageal fistula eroded through the membranous trachea, causing partial airway obstruction.

Discussion: This case represents a previously unreported complication of the use of polymer clips in esophageal atresia repair. The possibility of airway obstruction after thoracoscopic repair of esophageal atresia with a tracheoesophageal fistula should raise concern among pediatric surgeons and prompt further study into the use of plastic clips for this type of procedure.

Key Words: Tracheoesophageal fistula repair, Hem-o-lok clip, Thoracoscopic repair, Clip migration

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