Polymer Surgical Clip Migration Into the Trachea of an Infant

Introduction: Newborns with congenital esophageal atresia and a distal tracheoesophageal fistula undergo repair by several different approaches, the newest of which is thoracoscopic.The fistula is frequently occluded using a small polymer or titanium clip at the point of insertion into the trachea. Case Description:We report the case of a 1-day-old male newborn with proximal esophageal atresia and a distal tracheoesophageal fistula who underwent thoracoscopic repair and who then presented with respiratory distress 10 weeks later.The polymer Hem-o-lok clip (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) used to ligate the tracheoesophageal fistula eroded through the membranous trachea, causing partial airway obstruction.Discussion: This case represents a previously unreported complication of the use of polymer clips in esophageal atresia repair.The possibility of airway obstruction after thoracoscopic repair of esophageal atresia with a tracheoesophageal fistula should raise concern among pediatric surgeons and prompt further study into the use of plastic clips for this type of procedure.