HTF

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HTF

  1. 1. „H‟typeTracheo-esophageal FistulaSPEAKER- DR. VIJAYLAXMI SHRIVASTAVA DR. ASHWIN.A.JAISWALMODERATOR- DR.M.K.MOHANTYDEPARTMENT OF PAEDIATRIC SURGERY J.L.N.H & R.C, BHILAI Dnbpaediatrics.blogspot.in
  2. 2.  SIMMY 3 MONTHS/FEMALE NONCONSANGUINOUSMARRIAGE Dnbpaediatrics.blogspot.in
  3. 3.  NASAL REGURGITATION OF FEEDS SINCE DAY 15 OF LIFE RECURRENT PNEUMONIA SINCE BIRTH CHOKING ON FEEDING Dnbpaediatrics.blogspot.in
  4. 4.  HOSPITAL DELIVERY LSCS-MSAF VIGOROUS AT BIRTH BREAST FEEDING PHYSIOLOGICAL JAUNDICE Dnbpaediatrics.blogspot.in
  5. 5.  NASAL & ORALREGURGITATION OF FEEDSON LYING SUPINE EVENAFTER BURPING Dnbpaediatrics.blogspot.in
  6. 6.  RECURRENT PNEUMONIA TREATED ON OPD BASIS FOR 10 DAYS ADMITTED FOR PNEUMONIA FOR 15 DAYS THRICE IN 3 DIFFERENT HOSPITALS Dnbpaediatrics.blogspot.in
  7. 7.  REFERRED TO OUR HOSPITAL FOR NONRESOLUTION OF SYMPTOMS PEDIATRICIANS TREATED PNEUMONIA WITH ANTIBIOTICS Dnbpaediatrics.blogspot.in
  8. 8. Xray Dnbpaediatrics.blogspot.in
  9. 9. “DUE TO RECURRENCE OF PNEUMONIA POSSIBILITY OF GERD OR TRACHEOESOPHAGEAL FISTULA WAS SUSPECTED” Dnbpaediatrics.blogspot.in
  10. 10.  CASE WAS DISCUSSED WITH PEDIATRIC SURGEON BARIUM MEAL DONE –GERD RULED OUT Dnbpaediatrics.blogspot.in
  11. 11.  BRONCHOSCOPY DONE H-TYPE TRACHEOESOPHAGEALFISTULA WAS CONFIRMED Dnbpaediatrics.blogspot.in
  12. 12. PREOPERATIVE MANAGEMENT PROPPED UP POSITION MINIMAL HANDLING PROKINETIC AGENTS THICK SMALL FEEDS PNEUMONIA WAS TREATED Dnbpaediatrics.blogspot.in
  13. 13.  PLANNED FOR SURGERY PRIOR TO SURGERY PATIENT HAD PNEUMONIA TWICE EFFICIENTLY TREATED Dnbpaediatrics.blogspot.in
  14. 14. ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA COMMON LIFE-THREATENING MALFORMATIONS INCIDENCE OF 1 IN 3500 TO 1 IN 4500 BIRTHEQUAL SEX DISTRIBUTION / SLIGHT MALE PREPONDERANCE ASSOCIATED WITH CONGENITAL ANOMALIES (40-55%) Dnbpaediatrics.blogspot.in
  15. 15. Embryology Dnbpaediatrics.blogspot.in
  16. 16. Normal development of the Oesophagus and Trachea Dnbpaediatrics.blogspot.in
  17. 17. Gross-Vogt Classification Dnbpaediatrics.blogspot.in
  18. 18. Type A - EA without fistula / Pure EA(10%) Dnbpaediatrics.blogspot.in
  19. 19. Type B - EA with proximal TEF(<1%) Dnbpaediatrics.blogspot.in
  20. 20. Type C - EA with distal TEF (85%)
  21. 21. Type D -EA with proximal & distal TEF‟s(<1%) Dnbpaediatrics.blogspot.in
  22. 22. Type E - TEF without EA/ H-type fistula (4%) Dnbpaediatrics.blogspot.in
  23. 23. „H‟ TYPE TEF lamb ( 1873) Rare, isolated type of tef,4-5% m>f Level of fistula-2nd thoracic vertebra Dnbpaediatrics.blogspot.in
  24. 24. „H‟ TYPE TEF 70% occurs at /above the level of 2nd thoracic vertebra ( high as C7 and as low as T4) Types – „N‟ type & „H‟ type Oblique course –tracheal end cranially while esophagus caudally „N‟ type > „H‟ type Dnbpaediatrics.blogspot.in
  25. 25. „H‟ TYPE TEF Classical triad of symptoms Coughing & choking precipitated by feeds with or without cyanosis Recurrent lower respiratory tract infections Gaseous abdominal distension Dnbpaediatrics.blogspot.in
  26. 26. „H‟ TYPE TEF Excessive tracheal secretions with bubbly respirations Improvement of symptoms with gastric tube feedings Dnbpaediatrics.blogspot.in
  27. 27. „H‟ TYPE TEF Delayed diagnosis Least associated with congenital anomalies (25- 30%) Incidence of polyhydramnios is rare & lbw is less common Better prognosis Dnbpaediatrics.blogspot.in
  28. 28. DIAGNOSIS High clinical suspicion Cine esophagogram Rigid / Flexible Bronchoscopy CTscan /MRI / Radionuclide esophagogram Thoracoscopy Measurement of respiratory flow in esophageal lumen & o2 conc. in stomach Dnbpaediatrics.blogspot.in
  29. 29. BRONCHOSCOPY Dnbpaediatrics.blogspot.in
  30. 30. Surgical Management Bronchoscopic repair cauterization tissue adhesives application Ligation & repair of the TEF by cervical approach Thoracoscopic repair Repair of fistula by thoracotomy approach Nd-YAG laser coagulation Dnbpaediatrics.blogspot.in
  31. 31. Surgical Management LIGATION & REPAIR OF FISTULA BY CERVICAL APPROACH Dnbpaediatrics.blogspot.in
  32. 32. Anaesthesia Dnbpaediatrics.blogspot.in
  33. 33. Position Dnbpaediatrics.blogspot.in
  34. 34. Incision & Approach Dnbpaediatrics.blogspot.in
  35. 35. Identification ofTrachea & Oesophagus Dnbpaediatrics.blogspot.in
  36. 36. Identification of fistula Dnbpaediatrics.blogspot.in
  37. 37. Ligation of fistula atTracheal & Oesophageal end Dnbpaediatrics.blogspot.in
  38. 38. Repair of fistula with meticulous closure of Tracheal & Oesophageal end Dnbpaediatrics.blogspot.in
  39. 39. Post op investigations Gastrograffin study Dnbpaediatrics.blogspot.in
  40. 40. Healed Neck wound HAPPY BABY Dnbpaediatrics.blogspot.in
  41. 41. TEAM APPROACH PAEDIATRIC SURGEON PAEDIATRICIANEXPERIENCED TRAINEDENT SURGEON ANAESTHETIST Dnbpaediatrics.blogspot.in
  42. 42. THANK YOUVisit dnbpaediatrics.blogspot.in

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