Esophageal Atresia with Tracheoesophageal Fistula





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



Esophageal Atresia with Tracheoesophageal Fistula
Esophageal Atresia with Tracheoesophageal Fistula

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 connection to the trachea.

2- Type (B) : rare , proximal segment of esophagus opens into trachea , 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 .

- Child is unable to swallow effectively .

- Saliva or formula accumulate in upper esophagus pouch and is aspirated .

- Reguratiation of gastric acid.

- Abdominal distention may lead to respiratory distress.

Clinical manifestation :

- Appear soon after birth , excessive amount of secretions , constant drooling , intermittent cyanosis , abdominal distention , choking fluids retune through nose and mouth through feeding process.

- Inability to pass catheter through 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 stomach , tip of the catheter in blind pouch.

Complications and associated problems :

- pneumonitis ( salivary or gastric acid reflex ) , congenital heart disease , imperforated anus , prematurity.

Treatment :

- Propping infant at 30-degree angle to prevent reflux of gastric content.

- Suctioning.

- Supportive I.V fluids , antibiotic , respiratory support.

- Surgery.




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