ABSTRACT
Congenital stenosis of the oesophagus is a rare condition. There are three types: a membranous web or a diaphragm, fibro-muscular thickening and narrowing secondary to tracheobronchial remnants. Types 1 and 2 are located in the midportion of the oesophagus while type 3 is seen in the distal third of the oesophagus. Type 1 is the rarest and type 2 is the commonest variety of oesophageal stenosis. The first two conditions may be treated with dilatation but the third type usually needs surgical excision and end-to-end oesophageal anastomosis. Anastomotic leak results from a small, friable lower segment, which may be secondary to ischaemia of the oesophageal ends, excess anastomotic tension, myotomy, sepsis, poor suturing techniques, type of suture, excessive mobilisation of the distal pouch and increased gap length. Minimal mobilisation of the lower oesophageal segment helps prevent a recurrent tracheo-oesophageal fistula by minimising ischaemia. Diagnosis is made by oesophagram, rigid bronchoscopy and rarely by oesophagoscopy.
