A Rare Dual Atresia Case Report Introducing Gastric Distension-Assisted Esophageal Approximation (GDEA): A Hypothetical Novel Technique for Long-Gap Esophageal Atresia

Raed Al-Taher,1 Dina Mohammed,2 Dana Khaldun Atiyat,2 Mareh Abu-Hamdah2 1Department of General Surgery, Division of Pediatric Surgery, School of Medicine, The University of Jordan, Amman, Jordan; 2School of Medicine, the University of Jordan, Amman, JordanCorrespondence: Raed Al-Taher, Department of General Surgery, Division of Pediatric Surgery, School of Medicine, The University of Jordan, Amman, Jordan, Tel +962797277784, Email [email protected]: The simultaneous occurrence of pure esophageal atresia (EA) and duodenal atresia (DA) is an exceptionally rare congenital anomaly, posing significant diagnostic and surgical challenges. While each condition alone is well-documented, their coexistence is reported in only a small fraction of EA cases, and often necessitates complex, staged interventions. We present a unique case of a neonate with Down Syndrome diagnosed with both pure EA and DA. Intraoperatively, the esophageal segments were found in unexpectedly close proximity, allowing for a tension-free primary anastomosis—an outcome less likely achievable in pure EA which typically has a long-gap. Postoperative imaging confirmed DA, which was subsequently repaired. Despite initial surgical success, the patient experienced a complicated postoperative course and ultimately succumbed to multi-organ failure. This case highlights the diagnostic complexity and high morbidity associated with dual gastrointestinal atresia. Notably, the gastric distension caused by DA appeared to facilitate esophageal approximation, prompting the hypothesis of a novel technique: Gastric Distension-Assisted Esophageal Approximation (GDEA). GDEA proposes pyloric occlusion with monitored physiologic or controlled gastric loading—as a means to approximate esophageal segments in long-gap EA. This approach may offer a new adjunct to existing surgical strategies. The hypothesized GDEA technique, inspired by this case, introduces a potentially transformative concept in the treatment of long-gap EA. We emphasize that GDEA is a speculative hypothesis derived from a single clinical observation and is not supported by experimental or clinical evidence.Keywords: long-gap esophageal atresia, LGEA, duodenal atresia, dual gastrointestinal atresia, gastric distension-assisted esophageal approximation, GDEA, esophageal atresia type A