Bilateral choanal atresia in a low-resource environment: A case report and call for global health equity.

Purpose: Bilateral choanal atresia is a life-threatening neonatal emergency requiring prompt airway intervention. In resource-limited settings, diagnosis and management are often delayed due to systemic constraints. This case report describes the successful management of a neonate with bilateral choanal atresia in a low-resource environment and highlights the adaptive strategies used, with the aim of advocating for improved global pediatric surgical equity. Methods: A full-term female neonate presenting with severe respiratory distress immediately after birth was diagnosed with bilateral choanal atresia using bedside catheter testing and contrast radiography, as computed tomography (CT) was initially unavailable. Stabilization was achieved with an improvised oral airway fashioned from an endotracheal tube. Definitive surgery was performed at a tertiary center after a 5-day delay due to financial and logistical barriers. Results: Transnasal endoscopic puncture and dilation were performed using urethral dilators due to unavailability of balloon catheters. Custom stents were fashioned from silastic tubing. The neonate was discharged on postoperative day 5 with normal oxygen saturation and established oral feeding. Stents were removed at 6 months. Serial endoscopic follow-up over 3 years demonstrated sustained bilateral patency (>5 mm anteroposterior diameter) and age-appropriate growth and development. Conclusion: This case demonstrates that favorable long-term outcomes for bilateral choanal atresia are achievable in resource-limited settings through clinical innovation and sustained follow-up. However, significant delays and financial hardship underscore the urgent need for systemic investments in infrastructure, workforce training, and financing to ensure equitable access to life-saving neonatal surgical care globally.