J.Jpn. Surg. Soc.. 79(9): 1182-1187, 1978

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Report on the annual meeting

CONGENITAL ESOPHAGEAL STENOSIS AND ACHALASIA IN CHILDREN

The clinical features of congenital esophageal stenosis and achalasia in childhood have not been clearly delineated, because of lack of cases. A clinical review of these diseases is reported from a series of 125 cases, which consist of 41 cases associated with tracheobronchial remnants, 29 with fibromuscular stenosis, 6 due to membranous diaphragm, 29 with achalasia and 20 with stenosis of unknown causes. They consist of 7 cases from ours, 25 from Chugoku-Shikoku area and 93 from the literature.
Stenosis due to tracheobronchial remnants develops on the lower esophagus as in the case of achalasia. Esophagogram, esophagoscopy and esophageal manometry are helpful in estimating the differential diagnosis of both. Although, Heller's myotomy is effective for achalasia in children, the cases of tracheobronchial remnants are not amenable to this procedure. Segmental or partial resection of the stenotic part seems to be the favoured treatment.
Stenosis due to fibromuscular thickening is located on the middle or lower esophagus. The onset of its symptoms is seen mainly at newborn period against the case associated with tracheobronchial remnants at about 6 months of age. Long myotomy or partial resection of the esophagus are successful in relieving the obstruction. Dilatation can be also used effectively.
Congenital esophageal webs develop anywhere in the esophagus and the majority of the cases can be treated satisfactory by repeated bouginage.

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