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
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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