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Drooling of saliva
Harsh breath sounds
Abdomen is globular and full
Tracheoesophageal Fistula
A congenital or acquired communication between the trachea
and esophagus
A defect in the differentiation of the larynx & esophagus
occurring at about 24th28th week gestation.
Occurs in 1 of 30005000 births
Incomplete separation of the primitive foregut into respiratory &
digestive tracts at 4 weeks gestation
Associated anomalies are most common in pure esophageal
atresia without fistula & less common in Htype fistula
Vertebral/Skeletal: 2050%
Gastrointestinal: 25%
Cardiovascular: 25%
Tracheoesophageal Fistula
Clinical Manifestations:
Excessive salivation (drooling)
Frothy white bubbles in the mouth
Coughing or choking when feeding due to aspiration
Vomiting
Cyanosis, especially when the baby is feeding
Respiratory distress
Abdominal distention
Recurrent severe pneumonia
Differential Diagnosis
Pharyngeal pseudodiverticulum
Occur 2o to traumatic perforation of the posterior
pharynx from finger insertion into the oropharynx
during labor
Tracheal agenesis
Rare congenital malformation in which the trachea
may be completely absent (agenesis), or partially
in place but underdeveloped (atresia)
Zenker Diverticulum
Posterior hypopharyngeal pouch and
pharyngoesophageal diverticulum
Types:
Esophageal atresia
with Distal
tracheoesophageal
fistula: 87% (A)
Blind promixal +
blind distal: 8%(E)
H Type (Hard to
diagnose): 4%(D)
Proximal & Distal
TEF: <1% (C)
Proximal TEF +
Blind Distal:
<1%(B)
Diagnosis
Ancillary procedures
Ultrasound
• EA may be suspected prenatally
• Features: (reflect the absence of efficient
swallowing)
– Failure to visualize the stomach
– Presence of polyhydramnios
Plain Chest Radiograph
• If esophageal atresia is suspected, a
radiopaque 10 French catheter introduced to
the mouth becomes arrested at about 10 cm.
From the gums
• The prominent gastric bubble supports the
presence of a concurrent tracheoesophageal
fistula.
Contrast Studies
• Contrast studies are seldom required to confirm the
diagnosis.
• Risk:aspiration pneumonitis and pulmonary injury
• minimal information to the diagnostic workup.
• It is used when there is diagnostic uncertainty
Management – Preoperative
Phase
• risk of aspiration
– Maintain a partly upright position.
– Repeated suction of the blind esophageal pouch.
• Search for the presence of other anomalies
• Intravenous antibiotic therapy
• Provide energy intake (caloric intake) via intravenous
dextrose solution.
Management – Operative
Phase
• If the child is hemodynamically stable and oxygenating well –
repair may be performed 12 days after birth
Thoracotomy
Identify the fistula and then close with absorbable sutures which is
then divided.
Upper esophagus is mobilized to allow endtoend esophageal
anastomosis bet. The upper pouch and lower esophageal
segment
Postop course
• Contrast swallow 1 wk after repair –
assess the caliber of anastomosis,
determine if leak is present
• No leak – feedings started
Complications of Surgery
• Anastomotic Leakage
– 1015%, immediate postop or after several days
– Revision of anastomosis, if not possible cervical
esophagostomy and gastrostomy placement
Complications of Surgery
• Strictures
– 1020 % particularly if leak occurred
– Manifested by choking, gagging, failure to thrive,
clinically apparent with transition to eating solid
food
– Simple dilatation
Complicatons of Surgery
• GE Reflux
– Due to alterations in esophageal motility and
anatomy of GE junction
– Nissen fundoplication