Esophageal atresia is a congenital medical condition (birth defect) that affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather. Oesophageal atresia with or without tracheooesophageal fistula, OA, Congenital atresia of the esophagus with tracheo-esophageal fistula. Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival.

Author: Akinorisar Vudotilar
Country: China
Language: English (Spanish)
Genre: Sex
Published (Last): 22 August 2016
Pages: 469
PDF File Size: 7.73 Mb
ePub File Size: 10.93 Mb
ISBN: 345-6-75330-983-9
Downloads: 38747
Price: Free* [*Free Regsitration Required]
Uploader: Kagajora

Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies.

However, these findings have a low positive predictive value. The distance between the blind proximal oesophagus and the distal tracheooesophageal fistula varies from overlapping segments to a wide-gap.

Congenital esophageal stenosis due to tracheobronchial remnants: The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, esovagus, early surgical intervention, surgical materials and techniques.

Quality of ztresia in adult survivors of correction of esophageal atresia. Over time respiratory distress will develop.

The systems affected are as follows:. The surgery of infancy and childhood.

A complication that may occur with this technique is the undesired cutting of the esophagus by the sutures[ 43 ]. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. This technique is used to determine aatresia anatomy of the TEF with respect to the carina, to identify other airway anomalies and to occlude wtresia TEF with a balloon, facilitating mechanical ventilation and avoiding atresiz gastric distension and gastroesophageal reflux.

Others have advocated blocking of the fistula by a Fogarty catheter passed at bronchoscopy [ 49 ]. When a baby with a TE fistula swallows, the liquid can pass through the abnormal connection between the esophagus and the trachea.

This condition results from abnormal tracheal rings, deficiencies in cartilage, and an increase in length of the transverse muscle. Motor function of the esophagus after repair of esophageal atresia and tracheoesophageal fistula. Influence of congenital heart disease on management of oesophageal atresia. Support Center Support Center.

Pediatric Tracheoesophageal Fistula and Esophageal Atresia | Children’s National

The sutures are then tied sequentially while the tension is maintained. Infants with oesophageal atresia are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. At this stage, and certainly before the first feed, a stiff wide-bore 10—12 French gauge catheter should be passed through the mouth into the oesophagus.


Following the discovery of this anomaly, a left thoracotomy should be performed to the correct the EA[ 32 ].

The aim should be to re-operate in 8—10 days to divide the fistula and repair the oesophageal atresia. Symptoms of TE fistula or esophageal atresia may resemble other conditions or medical problems. At the end of the procedure, contrast is introduced into the oesophagus to ensure that there has been no perforation and to establish the effectiveness of the dilatation.

In other cases, another operation may be necessary to open up the esophagus so food can pass to the stomach properly. Madanick R, Orlando RC. Since [ 5051 ], we have advocated emergency transpleural ligation of the tracheooesophageal fistula as the procedure of choice in the infants with combination of problems.

Pediatric Tracheoesophageal Fistula and Esophageal Atresia

essofagus Furthermore, hospital stays tended to be shorter[ 39 ]. Severe tracheomalacia associated with esophageal atresia: Mutations in the human Sonic Hedgehog gene cause holoprosencephaly. The gap between the oesophageal ends is measured by injecting sufficient radioopaque contrast into the stomach to allow eosfagus to enter the distal pouch or by passing a bougie Hegar dilator or urethral sound through the gastrostomy site into the distal oesophagus.

Higher birthweight, moderate pneumonia and congenital anomaly.

Repair of esophageal atresia depends on how close the two sections of esophagus are to each other. Tracheo-oesophageal fistula and pre-operative mechanical ventilation. In either event, the balloon is carefully positioned under fluoroscopy at the centre of the stricture and contrast is gradually instilled under pressure until the “waisting” at the stricture is abolished.

Call your baby’s provider right away if the baby vomits repeatedly after feedings, or if the baby develops breathing difficulties. The lower esophageal pouch connects abnormally to the trachea. Nonetheless, the substitute should function as similarly as possible esofagys the original tissue[ 35 – 37 ].

The surgery of infancy agresia chilhood. Although this esifagus usually done through an incision between the ribs on right side of the baby, a technique using three small incisions thoracoscopy is being used at some centers. As a fetus is growing and developing in its mother’s uterus before birth, different organ systems are developing and maturing. Study of 24 cases with congenital esophageal atresia: On antenatal USG, the finding of an absent or small stomach in the setting of polyhydramnios was considered a potential aresia of esophageal atresia.


In the human, the evidence is less conclusive, with the Shh mutation leading to holoprosencephaly [ 32 ], a malformation not associated with oesophageal atresia. Gastric distention can complicate the ventilation of patients with large TEFs. A second cut is made at the level of the third mesenteric artery.

This procedure is extremely beneficial despite the requirement for a second thoracotomy, and its success is ensured by esophageal mobilization and the secondary atresa 434453 ].

Willis Potts [ 11 ] in wrote “To anastomose the ends of an infant’s oesophagus, the surgeon must be as delicate and precise as a skilled watchmaker. The trachea is also abnormal in oesophageal atresia. In this section More on this Topic. Management of isolated oesophageal atresia The diagnosis of isolated oesophageal atresia without a fistula should be suspected when on the initial radiograph there is no gas in the abdomen “gasless abdomen”.

The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux GEResophageal dysmotility, fistula recurrence, scoliosis, deformities of the thoracic wall and respiratory disorders[ 1 – 57374760 – 65 ]. The intrinsic innervation of the distal oesophagus has been shown to esovagus abnormal xtresia the fetal rate model and affects both excitatory SP-labelled and inhibitory VIP-labelled intramural nerves [ 39 ].

Just prior to the final suture being tied a transanastomotic fine-calibre naso-gastric tube may be passed. Delayed surgical intervention is accomplished at approximately three months of age with attempts at achieving a primary anastomosis.