Esophageal Atresia with Tracheoesophageal Fistula

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Esophageal Atresia with Tracheoesophageal Fistula

Esophageal Atresia with Tracheoesophageal Fistula:

Esophageal Atresia with Tracheoesophageal Fistula
Is malformation caused by the failure of the esophagus to develop a continues passage, the esophagus may or not form a connection with the trachea.

Esophageal Atresia:

Altered physiology :

Failure of septal development between trachea and esophagus, during the 4th week of gestation.

Types :

1- Type (A): 8% blind at each end of the esophagus, widely separated with a connection to the trachea.

2- Type (B): rare, the proximal segment of esophagus opens into the trachea, the distal end is blind.

3- Type (C): 80-90 %, proximal esophagus segment terminates in a blind pouch, and the distal segment is connected to the trachea or primary bronchus by a short fistula at or near the bifurcation.

4- Type (D): rare, both upper and lower esophagus segment connected to the trachea.

5- Type (E): 5% , fistula without atresia .

  • A child is unable to swallow effectively.
  • Saliva or formula accumulate in upper esophagus pouch and is aspirated.
  • Regurgitation of gastric acid.
  • Abdominal distention may lead to respiratory distress.

Clinical manifestation :

  • Appear soon after birth, an excessive amount of secretions, constant drooling, intermittent cyanosis, abdominal distention, choking fluids retune through nose and mouth through feeding process.
  • Inability to pass a catheter through the nose or mouth.

Diagnostic evaluation :

  • Recognize infants risk ” premature + polyhdramnios “.
  • Observe symptoms.
  • Inability to pass 10 -12 stiff catheter.
  • X-ray (chest and abdomen ) gas in the stomach, the tip of the catheter in a blind pouch.

Complications and associated problems :

problems :

  • pneumonitis ( salivary or gastric acid reflex), congenital heart disease, imperforate anus, prematurity.

Treatment :

  • Propping infant at 30-degree angle to prevent reflux of gastric content.
  • Suctioning.
  • Supportive I.V fluids , antibiotic , respiratory support.
  • Surgery: If surgery will be needed, and this can be done quickly after the infant has been stabilized.

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