Oesophageal atresia / Trachea Oesophageal Fistula

Question 1

Definition

Answer 1

o Congenitally interrupted esophagus o One or more fistulae may be present between the malformed esophagus and the trachea.

Question 2

According to the system formulated by Gross, the types of esophageal atresia and their approximate incidence in all infants born with esophageal anomalies are as follows

Answer 2

• Type A - Esophageal atresia without fistula or so-called pure esophageal atresia (10%)
• Type B - Esophageal atresia with proximal TEF (< 1%)
• Type C - Esophageal atresia with distal TEF (85%)
• Type D - Esophageal atresia with proximal and distal TEFs (< 1%)
• Type E - TEF without esophageal atresia or so-called H-type fistula (4%)

Question 3

Associated defects

Answer 3

• VACTERL association—vertebral anomalies (70%), anal atresia (imperforate anus) (50%), cardiac anomalies (30%), TEF (70%), renal anomalies (50%), and limb anomalies (polydactyly, forearm defects, absent thumbs, syndactyly) (70%)
• A single-artery umbilical cord is often present.

Question 4

Clinical manifestations

Answer 4

• history of polyhydramnios,
• exhibit drooling, and have mucus and saliva bubbling from the nose and mouth.
• Patients with a TEF are vulnerable to aspiration pneumonia. When TEF is suspected, the first feeding should be delayed until a diagnostic study is performed.

Question 5

Laboratory and Imaging Studies

Answer 5

• The simplest test for TEF is to gently attempt to place a 10F or larger tube via the mouth into the stomach. The passage of the tube is blocked at the level of the atresia.
• A chest x-ray reveals the tube coiled in the esophageal pouch.
• Air can be injected through the tube to outline the atretic pouch.
• Barium should not be used because of extreme risk of aspiration, but a tiny amount of dilute water-soluble contrast agent can be given carefully, then suctioned when the defect is clearly shown.

Question 6

Management

Answer 6

y Nurse head up and prone
y Pass a large bore tube and keep on low level suction to prevent aspiration of secretions
y Transfer to a surgical center when stable for repair