This document discusses two congenital conditions: Oesophageal Atresia and Congenital Diaphragmatic Hernia. Oesophageal Atresia involves a discontinuity in the esophagus that divides it into upper and lower pouches, sometimes associated with a tracheal fistula. It requires surgery to reconnect the esophagus or create an esophagostomy and gastrostomy. Prognosis depends on birthweight, associated anomalies, and pneumonia risk. Long term risks include stenosis and motility issues. Congenital Diaphragmatic Hernia occurs when the diaphragm fails to fully develop, allowing abdominal organs to enter the chest cavity and impair lung development. It can

1. Oesophageal Atresia

2. Complete obliteration or
discontinuity of the lumen.
Esophagus divided into a
upper(proximal) & a
lower(distal) pouch
May or may not be associated
with a tracheal fistula

3. Types
A B

4. C D E
Commonest
(90%)

5. Abnormal
pathology
• Blind upper
pouch
• Fistula
between
trachea & distal
Resulting
problems
• Aspiration –
saliva/milk
• Pneumonia
• Distension of
stomach
• Gastroesophage

6. Antenatal history
• polyhydramnios

7. Clinical features
-Antenatal – polyhydramnios
-Drooling of saliva
-if fed, milk regurgitates
-Respiratory distress
-Abdominal distension

8. Diagnosis

9. Pre op Treatment
• Upper pouch suction
• Antibiotics
• Head end elevation to
prevent reflux
• Respiratory support

10. Surgery
• Thoracotomy(Rt.)
Ligation of fistula
Esophageal end to end
anastomosis

11. Surgery
• If gap between the 2
esophageal ends is too much
then we have to divert•Cervical esophagostomy- outlet
for saliva
•Gastrostomy- for feeding
•Esophageal replacement when
the child is about older

12. Prognosis
•Birthweight
•Associated anomalies –
VACTERL
•pneumonia

13. Long term
• Stenosis
• Motility problems

14. CONGENITAL
DIAPHRAGMATIC HERNIA

15. Development of diaphragm
• Septum transversum
• Pleuroperitoneal membrane
• Esophageal mesentery
• Mesoderm of body wall

16. If diaphragm not developed completely
Bowel that is returning into abdominal
cavity enters thoracic cavity
Impaired development of lungs

17. • Can be detected antenatally
• Prognosis is worse if it is diagnosed before
24 weeks, stomach in chest

18. Clinical features
• Respiratory distress- cyanosis, tachpnoea,
tachycardia, sternal retraction
• Scaphoid abdomen
• Pseudo dextrocardia
• Absent breath sounds on left side

19. hypoxia
Pulmonary
vasoconstriction
Pulmonary hypertension
Persistent fetal
circulation (R to L
shunt)

20. Diagnosis

22. Treatment
• Physiological emergency
• May need ventilatory support &
stabilization
• Control pulmonary hypertension

23. Surgical treatment
• Laparotomy & repair of the defect

25. Newer treatment options
• Antenatal – PLUG therapy
• Post natatally – liquid ventilation, high
frequency ventilation