case_images: PMC10837038_01
case_images: (
  A
  ) Contour of the upper and lower esophageal pouches (white lines) at the time of broncho-esophagogastroscopy at our center showing the clip ~2 cm distal to the carina (clip) and the waist at the location of the tracheobronchial remnant (arrow). (
  B
  ) Endoscopic view of the first attempt at balloon dilatation of the tracheobronchial remnant. The cartilaginous ring is appreciable through the inflated balloon indicated by the white line (asterisks). (
  C
  ) Postoperative chest radiograph after approximation and placement of one Connect-EA magnetic anchor into the lower esophagus above the tracheobronchial remnant (TBR). (
  D
  ) Two stacked, endoscopically introduced magnetic anchors in the upper esophageal pouch (U) mated with the previously placed magnetic anchor in the lower esophageal pouch (L).
case_images: 10-1055-s-0044-1779042-i2023070716cr-1.jpg
case_images: PMC10837038_01_10-1055-s-0044-1779042-i2023070716cr-1.jpg
case_images: FI2023070716cr-1
case_images: Upon endoscopic exploration at our center, we identified a 2-cm diverticulum from the posterior wall of the trachea, as well as a short lower esophageal pouch that was interrupted by a tracheobronchial remnant in the form of a tight cartilaginous ring ( Fig. 1A ). To visualize the entire lower esophagus, a wire was placed under fluoroscopy and an unsuccessful attempt was made to dilate the tracheobronchial remnant with balloon dilation over the guidewire ( Fig. 1B ).  The patient was given 8 days with the magnet in place for the approximation to mature and the tension to subside ( Fig. 1C ).  Initially, the thickness of the esophageal tissue precluded a single upper anchor from mating sufficiently, so an additional Connect-EA magnetic anchor was stacked on top of the upper anchor to increase the magnetic force and facilitate a firm and secure attachment ( Fig. 1D ).
case_images: (
  A
  ) After 10 days, all three magnetic anchors were completely juxtaposed and saliva was found draining from the gastrostomy, indicating that the anastomosis had formed. However, the magnets did not pass distally spontaneously. (
  B
  ) Eight days after device removal, endoscopy demonstrated a widely patent esophageal anastomosis. (
  C
  ) The tracheobronchial remnant was slowly and progressively dilated until it ruptured. The image shows the separated ends of the cartilaginous ring (*) and the resulting mucosal defect (arrow). Care must be taken not to overdilate and thereby cause full-thickness disruption of the esophagus. (
  D
  ) An esophagram performed 1 month after magnet removal showed a patent esophagus with mild degree of narrowing at the site of the anastomosis (arrow).
case_images: 10-1055-s-0044-1779042-i2023070716cr-2.jpg
case_images: PMC10837038_01_10-1055-s-0044-1779042-i2023070716cr-2.jpg
case_images: FI2023070716cr-2
case_images: After 14 days, saliva started to drain from the gastrostomy, indicating patent anastomosis formation ( Fig. 2A ).  Eight days after device removal, the anastomosis was widely patent on endoscopy ( Fig. 2B ) and the tracheobronchial remnant was slowly dilated with increasing diameter until the cartilaginous ring ruptured at 12-mm diameter ( Fig. 2C ). An esophagram performed 1 month after device removal demonstrated a patent esophagus with a waist at the site of anastomosis ( Fig. 2D ).