{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:22:07Z","timestamp":1760059327185,"version":"build-2065373602"},"reference-count":9,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Esophageal atresia (EA) type A, characterized by the absence of a tracheoesophageal fistula and typically presenting with a long esophageal gap, usually requires staged repair. Methods: We report a rare case of a newborn with type A EA in which both the proximal and distal esophageal pouches were unexpectedly close and located in the cervical region. This anatomical variant allowed for a successful primary anastomosis through a cervical approach. Results: Initial imaging was misleading, and the true anatomy was clarified only through thoracoscopic exploration, underscoring the importance of intraoperative flexibility. Conclusions: To our knowledge, this is the first report of such a presentation in type A EA, with significant implications for diagnosis and surgical strategy.<\/jats:p>","DOI":"10.3390\/children12060740","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T09:02:03Z","timestamp":1749200523000},"page":"740","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mind the Missing Gap: A Cervical Variant of Type A Esophageal Atresia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0392-579X","authenticated-orcid":false,"given":"Marco","family":"Di Mitri","sequence":"first","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"},{"name":"Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3878-1415","authenticated-orcid":false,"given":"Riccardo","family":"Coletta","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"},{"name":"Department of Neurofarba, University of Florence, 50121 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Collautti","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"},{"name":"Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1708-3814","authenticated-orcid":false,"given":"Cristian","family":"Bisanti","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, IRCCS Sant\u2019Orsola, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0666-6515","authenticated-orcid":false,"given":"Annalisa","family":"Di Carmine","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, IRCCS Sant\u2019Orsola, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Lo Piccolo","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Rovero","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Tocchioni","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Severi","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Moroni","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Georgopoulos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aghia Sophia Children\u2019s Hospital, 115 27 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4583-5517","authenticated-orcid":false,"given":"Dariusz","family":"Patkowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5877-440X","authenticated-orcid":false,"given":"Mario","family":"Lima","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, IRCCS Sant\u2019Orsola, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"unstructured":"Baldwin, D.L., and Yadav, D. (2025, March 25). Esophageal Atresia, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560848\/.","key":"ref_1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/CM9.0000000000001673","article-title":"Detail correction for Gross classification of esophageal atresia based on 434 cases in China","volume":"135","author":"Yang","year":"2021","journal-title":"Chin. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.1016\/j.jpedsurg.2019.06.017","article-title":"Surgical treatment and major complications Within the first year of life in newborns with long-gap esophageal atresia gross type A and B\u2014A systematic review","volume":"54","author":"Stadil","year":"2019","journal-title":"J. Pediatr. 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Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/S0022-3468(85)80112-3","article-title":"Supraclavicular approach to cervical esophageal atresia with tracheoesophageal fistula","volume":"20","author":"Ford","year":"1985","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e938723","DOI":"10.12659\/AJCR.938723","article-title":"Preoperative Contrast Examinations Help Determine the Appropriate Cervical Approach for Congenital Gross Type C Esophageal Atresia: A Report of Two Cases","volume":"24","author":"Nakagawa","year":"2023","journal-title":"Am. J. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151231","DOI":"10.1016\/j.sempedsurg.2022.151231","article-title":"Anatomy and embryology of tracheo-esophageal fistula","volume":"31","author":"Durkin","year":"2022","journal-title":"Semin. Pediatr. 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