ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Surgery
This article is part of the Research TopicPediatric Vascular Anomalies: Advances and ChallengesView all articles
From Stridor to Symptom Relief; Management of Pediatric Kommerell's Diverticulum and Vascular Rings in Palestine [2016-2024]: A single center cohort study
Provisionally accepted
- Al-Quds University, Jerusalem, Palestine
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Background: Kommerell's diverticulum (KD) with vascular rings is an uncommon cause of pediatric airway and feeding symptoms, and data from the Arab region are scarce. We report a Palestinian cohort of all diagnosed and managed cases, describing presentation, diagnostics, and management. Methods: We retrospectively studied all children at Al-Makassed Hospital (Jerusalem) from 2016–2024 who were diagnosed with vascular rings + KD confirmed by imaging or intra-operative findings. We abstracted demographics, symptoms, test performance, anatomy, treatments, and peri-operative course and follow-up. Primary outcomes were diagnostic yield and improvement at last visit. Result: Fourteen patients were included; median age at diagnosis was 8 months (IQR 2–15), symptom onset 15 days (0–83). Thirteen (92.9%) were symptomatic; stridor (64.3%), recurrent wheeze (35.7%), and dysphagia/choking (28.6%) predominated; 42.9% had prior misdiagnoses. Barium swallow was positive in 7/8 (87.5%), echocardiography in 5/9 (55.6%), bronchoscopy in 10/12 (83%), and CT angiography (CTA) confirmed anatomy in 13/13 (100%). Anatomy included right aortic arch (RAA) with aberrant left subclavian artery in 8/14 (57.1%), double aortic arch in 4/14 (28.6%), and innominate artery compression in 2/14 (14.3%); 57.1% had minor intracardiac anomalies. Thirteen children (92.9%) underwent surgery (ligamentum division, diverticulectomy ± subclavian transfer, aortopexy, or double-arch division); one mild innominate compression case was observed. All were discharged alive; one late death occurred. At last follow-up, 7/13 survivors were asymptomatic and 6/13 had residual but improved symptoms. Median hospital stay was 18 days (IQR 7–25). Conclusion: KD-associated rings present early yet are frequently delayed in diagnosis. CTA is definitive, and tailored surgery yields meaningful, often complete, symptom relief with acceptable morbidity.
Keywords: Kommerell's diverticulum, Vascular rings, stridor, Dysphagia lusoria, aortopexy, Aberrant subclavian artery, Right aortic arch
Received: 25 Sep 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Amouri, Deeb, Sourkhi, Qasem, Abu Hadeed and Nasereddin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mohammad Amouri, mohammadamouri95@gmail.com
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