This document presents a case study on tracheoesophageal fistula (TEF). It begins with an introduction stating that TEF is a congenital abnormal connection between the trachea and esophagus. It is often diagnosed at birth and can cause life-threatening complications. The document then defines TEF and provides information on incidence, etiology, pathophysiology, signs and symptoms, diagnosis, management including pharmacologic and surgical approaches, nursing diagnoses, and complications. It aims to inform on the nature, causes, and treatment of TEF.

1. WELCOME

2. PRESENTED BY NIHARIKA
PBBSC N 1ST YEAR
CASE PRESENTATION ON
TRACHEAOESOPHAGEAL
FISTULA

3. INTRODUCTION
 A Tracheoesophageal fistula is a
congenital disease. It is a acquired
communication between the trachea
and esophagus. Most of the patient
with TEF are diagnosed immediately
following after birth.TEF are often
associated with life threatening
complications.

5. DEFINITION
 A Trachoesophageal fistula is an
abnormal connection between the
esophagus and the trachea. A fistula
from the Latin meaning a pipe is an
abnormal connection running either
between two tubes or between and a
tube and surface.

7. INCIDENCE
Approximate 17-70% of children with
TEFs have associated development
anomalies . These anomalies include
Down syndrome, duodenal Artesia
and cardiovascular defect.
 TEFs are a common congenital
anomaly with an incidence of 1 case in
2000-4000 live births.

8. ETIOLOGY
 Maternal alcohol and smoking
 Exogenous sex hormones
 Exposure to methimazole
 Prolonged mechanical ventilation via
Endotracheal or tracheotomy tube
 Maternal polyhydamnious
 In first trimester exposure to Diabetes
mellitus

9. PATHOPHYSIOLOGY
 Upper part of esophagus is developed from retropharyngeal
segment and the lower part of the first part of primitive gut.
 At 4-5 weeks of gestation the laryngeal-tracheal groove is formed.
 Two longitudinal furrows develop and separate the respiratory
tract permordium from esophagus.
 Deviation cellular growth of the septum results in formation of
fistula between esophagus and trachea.

10. SIGN AND SYMPTOMS
 Excessive secretion
 Intermittent, unexplained cyanosis and
laryngospasm
 Abdominal distention
 Violent response after first or second
swallow of feeding such as infant cough
and chokes fluid returns through nose
and mouth
 Poor feeding
 Inability to pass catheter

12. Diagnostic Evaluation
 Ultrasound scanning
 Failure to pass 10F into the stomach
through nose or mouth
 Catheter left in situ while an x- ray
diagnosis
 PH of tracheal secretions in acidic
 Flat plate x-ray of abdomen and chest
 Barium x-ray
 Electrocardiogram

13. PHARMOLOGIC MANAGEMENT
 Propping infant at 30 degree angle
 Nasogastric tube remains in the
esophagus and it is aspirated
frequently
 Nothing by mouth
 Supportive therapy include meeting
nutritional requirements IV fluid,
antibiotics , respiratory support and
maintaining neutral environment

14. SURGICAL MANAGEMENT
 Prompt primary repair: fistula found by
bronchoscopy is divided, followed by
esophageal anastomosis of proximal and
distal segments if infant weight permit and is
with out pneumonia.
 Staging: Initially fistula division gastrostomy
are performed with later secondary
esophageal anastomosis or colonic
transposition performed approximately 1
year later to effect total repair

15. CONTI
 Circular esophagotomy: It may be
performed on proximal pouch to gain
length and allow foe primary
anastomosis at initial surgery.
 Cervical esophagotomy : When ends
of esophagus are too widely
separated ,esophagus replacement
with segment of intestine (colonic
transposition ) is done at ages 18 to
24 months.

17. Continue
 Fiberoptic Tracheoscopy: Repair of
trachesophageal fistula can expedite
and facilitate surgery on ventilated
patient.
 COMPLICATIONS;
 Esophagitis
 Esophageal strictures
 Recurrent fistula
 Death from asphyxia
 Pneumonitis
 Dehydration

18. NURSING DIGNOSIS
 Risk for aspiration related to structural
abnormalities as evidence by neonate
is not able to swallow.
 Fluid volume deficit related to inability
to take oral fluids as evidence by nil
per oral status.
 Ineffective airway clearance related to
surgical intervention.
 Fear and anxiety of the parents
related to critical situation of neonate
as evidence by parents look anxious.

19. CONTINUE
 Acute pain related to surgical procedure
as evidence by child is continuously
crying.
 Ineffective infant feeding pattern related
to congenital defect.
 Impaired tissue integrity related to post
operative defect.
 Knowledge defect related to home base
care as evidence by parents asking so
many question regarding disease

20. THANK YOU