OESOPAHGEAL ATRESIA

Incidence

1:4500 live births

Equal sex distribution

Types

1 proximal atresia with distal tracheoesophageal fistula 87%

2 distal atresia within proximal tracheooesophageal fistula 0.8%

3 isolated atresia 7%

4 H shaped tracheooesophageal fistula 4%

Clinical features:

Prenatal if mother has polyhydraminos 30% (fetal ultrasound: absent or small stomach, blind upper oesophageal pouch filing and emptying)

1 60% infants excessive mucus because of saliva in blind upper pouch

PFA CXR => confirm diagnosis, hold up of catheter, air in stomach, distal TOF

2 Respiratory distress

3 Inability to swallow

4 Cyanotic or choking episode on attempts to feed

Associated anomalies:

( vater or vacteryl)

Cardiac: VSD, Fallots 29%

Vertebral/skeletal 10%

Anorectal 14%

Genitourinary 14%

Gastrointestinal 13%

Respiratory 6%

Genetic 4%

Misc. 11%

Management

Pre op: continuous N/G suction, U/E correction, normothermic, stable,

Urgent: pretrem, respiratory distress => gastric distention =>perforation=>tension pneumoperitoneum

Operative procedures

1 atresia with distalTOF : right posteriolateral 4-5 intercostal extrapleural thoracotomy,

    Single layer full thickness fine interrupted sutures,

    Thoracotomy closed without need of pleural drain

2         Isolated esophageal atresia if the distance between the two ends is great primary anastomosis not feasible, a/ gastrostomy, b/delayed primary closure c/ cervical oesophagostomy esophageal replacement procedure later

3         H shaped TOF : lower transverse cervical incision fistula divided ends repaired

Postoperative care:

ET tube removed at the end of operation

N/G feed 2-4 post op day

Complications:

Early

1 Aanastomotic leakage 10% minor radiological seal spontaneously,

                                                         Major=> tension pneumoperitoneum requiring urgent repair.

2         Recurrence TOF 8% => choking, cyanotic episode during feeding, recurrent UTI’s.

            Diagnosis on cine tube oesophagoscopy treatment is closure of fistula? Laproscopically.

3         stricture 30% anastomotic stricture requires one or more dilatation’s , intractable stricture usually related to GOR

Late :

Tracheomalacia structural and functional weakness of trachea => partial respiratory obstruction=. Present with barking cough, cyanotic attack during feeding, near miss SIDS

Diagnosis on Bronchoscopy Treatment Aortopexy

GORD 25% need surgical treatment because of failure of medical treatment

Disordered esophageal motility inherent feature>food bolus obstruction =>treatment fluids with food

Disappear in adult life

RTI increased tendency for RTI’s because of disordered esophageal motility ,GORD, tracheomalacia, abnormality of respiratory epithelium, frequency decreases within age

Prognosis:

Birth weight > 1500gms + no cardiac abnormality 97%

Birth weight < 1500gms or major cardiac abnormality 59%

Birth weight < 1500gms and major cardiac abnormality 25%

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