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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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Esophageal atresia

Esophageal atresia


Esophageal atresia


Esophageal atresia

Presentation 1 /4,000 neonates

-Frothing or bubbling of the mouth and nose after birth

- Drooling

- Choking

-Episodes of coughing, cyanosis and respiratory distress


Esophageal atresia

Diagnosis 1 /4,000 neonates

  • 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


Esophageal atresia

Preoperative 1 /4,000 neonatesManagement

-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


Esophageal atresia

Features 1 /4,000 neonates

  • 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)


Esophageal atresia

Surgical management 1 /4,000 neonates

-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 1 /4,000 neonates

  • 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 1 /4,000 neonates

  • 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%