A 26-day-old male with no relevant family, prenatal or perinatal history.
Towards three weeks of life, vomiting began, which increased, and the day before admission, abundant and projectile vomiting occurred with each intake.
The patient was eager to eat and in good general condition.
When present in the Emergency Department, there was a clinical suspicion of pylorus stricture supported by a metabolic alkalosis and ultrasound with characteristic target image.
The patient underwent open surgery using the Ramstedt technique, without incidents.
Before the procedure, the patient was intubated without complications.
Fourteen hours after surgery, the stridor with predominantly inspiratory stridor was heard for the first time, but did not change with sleep, position or feeding.
The mother was reinterrupted and asked to hear it earlier.
The patient had no respiratory distress or oxygen desaturation on pulse oximetry.
Since the patient was previously healthy and had not been heard stridor before, operative intubation and associated posttraumatic edema could be the cause.
Nebulization plus intravenous dexamethasone was administered.
After two hours, the stridor had not changed, and as the patient continued without signs of respiratory distress, the approach to this problem began.
A simple chest X-ray showed no abnormalities in the lung parenchyma, neck structures or tracheal air column.
Subsequently, through a flexible nasolaryngoscopy, supraglottic structures and intact vocal cords were verified, without morphological alterations or abnormal movements.
The next step was the performance of a fluoroscopic series with oral contrast, which showed a wrist in the posterior wall of the upper third of the esophagus.
During this time the patient showed no changes in his symptoms.
After the pylorus surgery he had not presented vomiting again.
There were no data on respiratory distress associated with stridor at any time.
Days later, bronchoscopy revealed compression of 2 cm above the carina, pulsating pressure or not more than 50% of the tracheal lumen.
due to the strong suspicion of tracheal arch that was responsible for the decrease in tracheal caliber, computed tomography angiography (CT-angio) was performed, in which a complete double aortic arch could be identified, with predominance of the right atrium.
Echocardiography was normal.
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The patient was operated by means of a left lateral thoracic approach surgery that was performed without interruption.
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In the first hours after surgery, there was a significant decrease in the intensity of inspiratory noise.
She was discharged and during the following weeks residual stridor continued to decrease.
She did not present respiratory or digestive symptoms again, and in a follow-up consultation two months after surgery the stridor ended up disappearing completely.
