esophageal atresia
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Esophageal atresia. Most frequent congenital anomaly of the esophagus, affecting 1 /4,000 neonates an abnormality in which the middle portion of the esophagus is absent. The esophagus may end blindly into a pouch or may connect to the trachea

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Presentation Transcript
slide2

Most frequent congenital anomaly of the esophagus, affecting 1 /4,000 neonates

  • an abnormality in which the middle portion of the esophagus is absent. The esophagus may end blindly into a pouch or may connect to the trachea
  • >90% have an associated tracheoesophageal fistula (TEF)
slide5

Presentation

-Frothing or bubbling of the mouth and nose after birth

- Drooling

- Choking

-Episodes of coughing, cyanosis and respiratory distress

slide6

Diagnosis

  • Prenatal ultrasound- maternal polyhydramnios
  • inability to pass a nasogastric or orogastric tube in newborn
  • Plain radiography- shows radiolucent, blind-end dilated pouch of upper esophagus
  • On lateral view
    • Anterior displacement of trachea
    • Rarely, air-fluid level in pouch
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Preoperative Management

-maintain a patent airway

-prevent aspiration of stomach contents or saliva into the lungs

-prone position to prevent stomach secretions from refluxing into lungs

-Intravenous antibiotics to help prevent the development of pneumonia

-The "VACTERL" workup is completed prior to surgical repair

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Features

  • V - Vertebral anomalies
  • A - Anal atresia
  • C - Cardiovascular anomalies
  • T - Tracheoesophageal fistula
  • E - Esophageal atresia
  • R - Renal (Kidney) and/or radial anomalies
  • L - Limb anomalies (in front of or above the central axis of the limb)
slide11

Surgical management

-Primary anastamosis of proximal and distal esophagus usually when infant is a few months old

-gastrostomy, gastric pull-up, colonic transposition and jejunum transposition

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postoperative care
Postoperative care
  • Postoperatively patients may be extubated as tolerated.
  • Any attempt at reintubation should be performed carefully in order to avoid accidental and catastrophic intubation of the esophagus.
  • The head is flexed slightly forward in order to decrease tension on the esophagoesophagostomy.
  • Oral suctioning performed only to the level of the pharynx.
  • Endotracheal tube suctioning must be performed carefully in order to avoid trauma or perforation at the site of the TEF closure.
outcome
Outcome
  • Current overall survival rates= 85% - 90%
  • Mortality is usually secondary to associated anomalies.
  • Immediate postoperative complications include:
      • anastomotic leak in 15% of cases.
      • stricture formation in approximately 15% of cases
      • recurrent tracheoesophageal fistula in 5% of cases and requires reoperation with division and ligation of the fistula
  • The most common long term problems :
      • Gastroesophageal reflux in up to 70%
      • Tracheomalacia in approximately 25%
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