is a disorder of the digestive system in whichthe esophagus does not develop properly.
Atrasia: Congenital absence or closure of a normal body opening. Normal Atrasia
Fisula:Is a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body. Normal Fistual
1 case in 3000-4500 births. thehighest incidence of this disorder is in Finland, where it is 1 case in 2500 births.
2% risk of recurrence is present when a sibling is affected. Increase in advanced maternal age.
Atweek 4 , the Tracheabroncheal diverticulum developed to Tracheabroncheal sputum. There is a failure to separation in the sputum leading to fistula. During week 8, the primitive gut failure to recanalization. That lead to atrasia.
Type A - Esophageal atresia without fistula or so- called pure esophageal atresia (10%) Type B - Esophageal atresia with proximal TEF (< 1%) Type C - Esophageal atresia with distal TEF (85%) Type D - Esophageal atresia with proximal and distal TEFs (< 1%) Type E - TEF without esophageal atresia or so- called H-type fistula (4%) Type F - Congenital esophageal stenosis (< 1%) (This is not discussed in this article)
Currently,most authorities believe that the development of esophageal atresia has a nongenetic basis. Ina 1987 Kluth eschews has the concept that esophageal vascular events, ischemic events, or both may be causes in cases of esophageal atresia without fistula. In 2003, Spilde et al reported esophageal atresia-TEF formations Adriamycin induced teratogenesis.
(VACTERL) Vertebral defects. Anorectal malformations. Cardiovascular defects. TrachoEsophageal deffect. Renal anomalies. Limb deformities. 25% of all patients with esophageal atresia
A fetus with EA cannot effectively swallow amniotic fluid.A fetus with esophageal atresia and a distal TEF, amniotic fluid presumably flows through the trachea and down the fistula to the gut Polyhydramnios premature labor
The neonate with EA cannot swallow and there is copious amounts of saliva. Aspiration of saliva or milk, if the baby is allowed to suckle, can lead to an aspiration pneumonitis.
In a baby with esophageal atresia and a distal TEF, the lungs may be exposed to gastric secretions. Also, air from the trachea can pass down the distal fistula when the baby cries, strains, or receives ventilation. This condition can lead to an acute gastric perforation, which is often lethal.
Renal UltraSonographyis used to evaluate associated kidney anomalies, ureteral anomalies, or both.
Echocardiography.who have clinical signs of cardiovascular disease.
Limb radiography if the limbs appear abnormal.
Preoperative management:1. The oral pharynx should be cleared.2. The infants head should be elevated.3. IV fluids (10% dextrose in water).4. Oxygen therapy is used.5. In infants with respiratory failure, endotracheal intubation should be performed.6. broad-spectrum antibiotics(such as ampicillin plus gentamicin)
Surgical techniques vary according to surgeons preferences and variations in pathologic anatomy. Thebest esophagus is the patients esophagus.
Infantsborn with esophageal atresia without fistula early gastrostomy
Kimura, Livaditis, Scharli, or Foker procedures
Infantsborn with esophageal atresia with fistula early gastrostomy
Roberta A Pagon, Editor-in-chief, Thomas D Bird, Cynthia R Dolan, Karen Stephens, and Margaret P Adam, GeneReviews™, Seattle (WA): University of Washington, Seattle; 1993. Amulya K Saxena, Esophageal Atresia With or Without Tracheoesophageal Fistula, Medscape. eMedicine, Updated: Apr 25, 2012, link: (http://emedicine.medscape.com/article/935858-overview#showall ) DWAYNE C. CLARK, Esophageal Atresia and Tracheoesophageal Fistula, 1999 Feb 15;59(4):910-916. Kronemer KA, Snyder-Warwick A. Esophageal atresia/tracheoesophageal fistula. 2008. Available online at eMedicine. Accessed 4-1-11.