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ESOPHAGEAL ATRESIA WITH/WITHOUT TRACHEOESOPHAGEAL FISTULA


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Authors:  Vivek Gharpure

Institute: Department of Pediatric surgery, Children’s Surgical Hospital 13, Pushpanagari, Aurangabad, 431001, India

Address for Correspondence: Dr Vivek Gharpure, Department of Pediatric surgery, Children’s Surgical Hospital 13, Pushpanagari, Aurangabad, 431001, India

          *Email: vvgharpurel@dataone.in

 


ISSN:2226-0439

Journal of Neonatal Surgery

Volume 1(1), Jan-Mar 2012


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Submitted On: 25-11-2011

Accepted On: 06-12-2011

 Published on: 01-01-2012

Local ID: jns-2012-1-19

J Neonat Surg 2012;1(1):16

© Gharpure V, 2012, EL-MED-Pub Publishers

Conflict of Interest: None declared

Source of Support: Nil

 


How to cite:

Gharpure V. Esophageal atresia with/without tracheoesophageal fistula. J Neonat Surg 2012;1:16.

 


 

QUESTIONS

  1. What clinical and sonographic features should make one suspect esophageal atresia in a pregnancy?
  2. What is the quickest method of diagnosing esophageal atresia, with or without tracheo-esophageal fistula (TEF)?
  3. What management principles should be followed in a newborn with esophageal atresia ± TEF till surgery is carried out?
  4. What difficulties are encountered in a newborn with esophageal atresia ± TEF and right aortic arch?
  5. What are advantages and disadvantages of trans-anastomotic tubes in esophageal atresia ± TEF?
  6. What are the management options in anastomotic leak in esophageal atresia ± TEF repair?
  7. What immediate postoperative care is recommended in a neonate operated for esophageal atresia ± TEF?
  8. What long term follow-up is recommended in a survival of esophageal atresia?
  9. What management options are available in a child who develops stricture at anastomotic site following esophageal atresia ± TEF repair?
  10. What are different investigations in a child suspected to have H type TEF

 


ANSWERS

  1. Polyhydromnios, small gastric bubble, dilated upper esophageal pouch [1].
  2. Pass a soft blunt tipped rubber catheter through mouth. If it arrests at 10 cm from gum margin, baby has esophageal atresia. Observe the stomach; if it is scaphoid, baby may have isolated esophageal atresia, if it is distended, baby is likely to have TEF [1].
  3. Frequent upper pouch suction, semi-erect position, hydration, antibiotics, stop feeds, vitamin K, and warmth [1].
  4. Lower esophageal segment concealed under the descending aorta, difficult to locate, anastomosis touched by pulsating aorta, iatrogenic injury to vital structures due to unfamiliarity with anatomy [1].
  5. Transanastomotic tubes allow early feeding, prevent catabolism, and prevents double bites of esophageal wall; but can obstruct esophageal lumen and prevent salivary drainage leading to secretions in throat, compromised anastomosis [2].
  6. These are; TPN; Gastrostomy/jejunostomy feeds/Transanastomotic tube feeds; Oral feeds if leak is small; Drainage of leak; Esophagostomy and gastrostomy [1,2].
  7. These are; Upper pouch suction; Chest physiotherapy; Humidified oxygen; Analgesics; Care of chest tube/NG tube [2].
  8. Monthly weight record for first few months; Esophageal calibration for first year; Growth monitoring every year; Investigate for dysphagia; Evaluate for GER if suspicion [2].
  9. Anti-reflux measures such as position, Thick formula feeds; H2 blockers; Dilatation; Dilatation and local bleomycin/steroid; Balloon dilatation; Stricturoplasty; Replacement [1,2].
  10. Barium swallow; Esophagoscopy/bronchoscopy; CT/MRI [1,2].


REFERENCES
  1. Puri P, Höllwarth ME, editors. Pediatric surgery-diagnosis and management. Springer; 2009. pp. 331.

  2. Beasley SW, Myers NA, Auldist AW, editors. Esophageal atresia. Chapman and Hall Medical, London;1991. pp. 112-3.


This is an Open Access article distributed under the terms of the Creative Commons Attribution unported License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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