OESOPHAGEAL ATRESIA EXPLAINED ALONGWITH TRACHEO-OESOPHAGEAL FISTULA , ITS TYPES , SIGNS AND SYMPTOMS AND TREATMENT

1. OESOPHAGEAL
ATRESIA
PRESENTED BY:-
VISHESH MOHAN
SAXENA

2.  Oesophageal atresia is a congenital medical condition
 In this condition, usually the upper oesophagus ends and
does not connect with the lower oesophagus and stomach.
 In 85% cases, it is a blind upper end with lower end
communicating with trachea .

3.  It is a spectrum of anomalies which shares a defect of the
oesophageal continuity with or without a fistula to the
trachea or bronchi .
 It may be associated with VACTER anomalies.
V – Vertebral defects
A - Anal atresia
C- Cardiac defects(PDA/VSD)
TE- Tracheo-oesophageal fistula
R – Radial hypoplasia and renal agenesis

4. TYPES:
1) TYPE A :- Most commonest type ( occurs in 90% of the cases)
The upper oesophageal segment ends blindly and the lower portion
of the oesophagus is connected with the trachea through tracheo-
oesophageal fistula.
The oesophageal fistula usually joins the trachea at or just above
the tracheal bifurcation, admitting inspired air into the stomach, or
in retrograde fashion gastric juice into the lungs.

5. 2) Type B :- Both upper and lower oesophageal segments end
blindly with a portion of oesophagus in between missing.
This is seen in 8%-10% of the cases.

6. 3) Type C :- The proximal segment of the oesophagus is
connected with by tracheo-oesophageal fistula, while the
distal segment of the oesophagus ends blindly.
Occurs in 1%-2% cases.

7. 4) TYPE D:- Both proximal and distal segments of the
oesophagus are connected with the trachea by tracheo-
oesophageal fistula.
Occurs in <1% cases.

8. 5) Type E :- An isolated tracheo-oesophageal fistula without
atresia H-type fistula has been isolated , although it
belongs to a different spectrum because the oesophagus is
patent.
Occurs in 3% cases.

9. Clinical features :-
 Incidence is 1 in 4500 births ; common in males (3:1)
 Continuous drooling of saliva from the mouth in the
newborn baby is the diagnostic feature.
 Newborn baby regurgitates all feeds.
 Persistence in feeding may produce aspiration, choking,
cough and cyanosis.
 It is commonly associated with maternal hydramnios
(50%).
 TOF should be recognised & diagnosed within 24hrs of
birth – by introducing a RED RUBBER CATHETER.

11. INVESTIGATIONS
 Obstruction is revealed while passing nasogastric tube.
 Contrast study will reveal fistula and obstruction(DIONOSIL 1 ml).
 In straight X-ray, air in the stomach confirms the first type of anomaly
in which the lower end of the oesophagus is connected with the
trachea.
 Investigation of choice for the diagnosis with histopathological proof is
endoscopic proof.
 Investigation of choice to identify haematogenous metastasis is CT-
scan.

12. MANAGEMENT
 Surgical intervention should be immediate.
 The baby is kept in 30 degree head-up position.
 The child requires feeding gastrostomy commonly.
 Right sided thoracotomy (opposite to the side of aortic arch ),
fistula is identified and resected .
 Lower segment is anastomosed to the blind upper segment.
 Occasionally if the length is inadequate or the atretic segment is long one,
then colonic or gastric transposition is required.

13. COMPLICATIONS
 Leak from anastomotic site
 Mediastinal infection is occasionally seen
with oesophageal disruption.
 Pneumonia
 Gastro-oesophageal reflux
 Dysphagia