Abstract
INTRODUCTION: Pure esophageal atresia without a tracheoesophageal fistula (Gross type A) is technically demanding, particularly with respect to intraoperative identification of the distal esophageal pouch. Biologically transparent illumination (BTI) devices have been used to visualize nasogastric tubes in pediatric patients; however, their application during esophageal reconstruction has not been reported. CASE PRESENTATION: A male neonate with prenatally suspected esophageal atresia was diagnosed postnatally with Gross type A esophageal atresia. After gastrostomy and serial bougienage of both esophageal pouches, definitive esophageal reconstruction was performed at 106 days of age. At right thoracotomy, the proximal esophageal pouch was readily identified, whereas the distal pouch was deeply located within the mediastinum and could not be detected visually. A BTI catheter emitting red light from its tip was introduced into the distal esophageal pouch via gastrostomy. Activation of the device allowed clear transillumination through surrounding tissues, enabling accurate localization of the distal esophagus. Subsequent mobilization and end-to-end esophageal anastomosis were successfully completed. Postoperative contrast esophagography showed no evidence of anastomotic leakage or stricture, and enteral feeding with milk was initiated on POD 7. The patient was discharged on POD 24 and has remained free of complications during 10 months of postoperative follow-up. CONCLUSIONS: This case demonstrates that BTI is a useful device for localizing the distal esophageal pouch during surgery in Gross type A esophageal atresia. The technique may facilitate safer and more reliable esophageal reconstruction in technically challenging pediatric cases.