J Surg Case Rep

. 2025 May 29;2025(5):rjaf333.

 doi: 10.1093/jscr/rjaf333. eCollection 2025 May. https://pubmed.ncbi.nlm.nih.gov/40453740/

The boy who lived: staged repair of congenital diaphragmatic hernia with esophageal atresia and tracheoesophageal fistula in a 32-week, 1.5 kg infant, and review of the literature

John M Woodward ^1 2, Patricia Corujo Avila ¹, Bobby Mathew ³, Kathryn D Bass ⁴, P Benson Ham Rd ^1 2

Affiliations Expand

• PMID: 40453740
• PMCID: PMC12124474
• DOI: 10.1093/jscr/rjaf333

Abstract

Congenital diaphragmatic hernia (CDH) associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF) is a rare and often fatal combination with reported survival rates of 6%-26%. We aim to analyze the literature on left sided CDH with EA and TEF and report our experience, hypothesizing that delaying right chest approach for EA/TEF repair improves outcomes. We report a case of a 1.5 kg 32-week patient who survived a staged approach of initial CDH repair and abdominal control of TEF with gastrostomy to water seal and vessel loop encircling the gastroesophageal junction followed by EA/TEF repair at 18 days of life. This case report and review of the literature highlights the benefit of a staged surgical approach for left CDH, EA, and TEF; initially proceeding with CDH repair and abdominal control of the TEF first, followed by EA/TEF repair once the patient stabilizes.

Keywords: congenital diaphragmatic hernia; esophageal atresia; improved survival; pediatric surgery; staged surgical approach; tracheoesophageal fistula.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2025.