Esophageal Atresia

The esophageal designated an incomplete formation of the esophagus, which is often associated with a tracheoesophageal fistula. The diagnosis is made by the futile attempt to push a nasogastric or oro-gastric tube into the stomach. The treatment of choice is surgical recovery.

The esophageal designated an incomplete formation of the esophagus, which is often associated with a tracheoesophageal fistula. The diagnosis is made by the futile attempt to push a nasogastric or oro-gastric tube into the stomach. The treatment of choice is surgical recovery.

(See also Congenital abnormalities of the gastrointestinal tract in the overview.) The esophageal atresia called an incomplete formation of the esophagus, which is often associated with a tracheoesophageal fistula. The diagnosis is made by the futile attempt to push a nasogastric or oro-gastric tube into the stomach. The treatment of choice is surgical recovery. The esophageal atresia is the most common GIT atresia. The estimated incidence is 1 in 3500 live births. Other congenital malformations account for up to 50% of cases. Two syndromes are particularly associated with esophageal atresia: VACTERL (Vertebral Anomalies, Anal atresia, Cardiac Malformations, Tracheoesophageal fistula, esophageal atresia, Renal Anomalies and radial aplasia, Limb Anomalies) include vertebral malformations with one. Harge (Coloboma, Heart Defect, atresia of the Choana, retardation of mental and / or physical development, Genital hypoplasia, Ear Abnormalities) About 19% of children with esophageal atresia meet criteria for VACTERL. There are five main types (types and relative frequencies of esophageal atresia and tracheoesophageal fistula.). Most of these types are associated with a fistula between the trachea and esophagus. Most infants show evidence during the neonatal period, but infants with an H-type fistula can also show symptoms until later in life. Characteristic symptoms are excessive secretion, cough and cyanosis after swallowing tests and aspiration pneumonia. The esophageal atresia with distal fistula leads to a distended abdomen, since air from the trachea is pushed through the fistula into the lower esophagus and the stomach, once the infant cries. Types and relative frequencies of esophageal atresia and tracheoesophageal fistula. Relative frequencies based on different sources. Prenatal diagnosis: Sonography Postnatal: placement of a nasogastric oser orogastric probe and X-ray examination, routine prenatal ultrasound examination may indicate esophageal atresia. Polyhydramnios may be, but is not diagnostically relevant because it can occur with many other diseases. The fetal stomach bubble may be absent at <50% of cases. Less frequently there is an extended upper Ösophagussack, but this is usually detected only in fetuses with polyhydramnios and without stomach bubble. After the birth of a nasogastric or oro-gastric probe is inserted when a esophageal atresia is suspected by prenatal ultrasound or clinical findings; the diagnosis of esophageal atresia is provided by the impossibility to bring the tube into the stomach. A radiopaque catheter can show the location of the atresia on the radiograph. In atypical cases have to contribute a small amount of water-soluble contrast agent into the upper esophagus to assess the anatomy under fluoroscopy. The contrast agent has to be sucked then, as it can cause chemical pneumonitis, as it enters the lungs. This investigation should be conducted by an experienced radiologist and in the center, which also houses the surgery takes place. Therapy Surgical intervention The aim of preoperative treatment is the ideal preparation of the child for the surgery and the prevention of aspiration pneumonia, which could make surgical correction more dangerous. Oral nutrition is not permitted. Continuous aspiration with a nasogastric tube in the upper Ösophagussack prevent aspiration of swallowed saliva. The prone position is recommended, the head should be raised by 30-40 °. The face should be inclined to the right side to promote the emptying of the stomach and thus reduce the risk of aspiration of gastric juice through the fistula. If the final surgical procedure must be moved because the child is very immature, has aspiration pneumonia or for any other congenital anomalies, the stomach is relieved with a gastrostomy tube. The suction through the gastrostomy tube reduces the risk of reflux of gastric contents through the fistula in the Trachealbaum. Surgical intervention If the condition of the infant is stable, extrapleural surgery can be performed to correct the esophageal atresia and close the tracheoesophageal fistula. If a fistula is detected, it must be ligated. In about 90% of the cases, a primary anastomosis of the esophagus can be performed. In the remaining cases where an extremely long gap exists are a gastric transposition process (gastric transposition procedure) or a colon intermediate procedure (colonic interposition procedure) options. Some pediatric surgeons call the "Foker- method" (Foker procedure) to. In this method traction sutures are placed at the ends of the esophagus bags, brought through the skin and fixed with Silastic buttons. Pulling force is gradually applied to the threads, which stimulate the expansion of the esophagus by 1 to 2 mm / day. Once the ends of the esophagus have come together or are in close proximity, then a primary anastomosis (1). The most common acute complication is a leak in the anastomosis or cicatricial. In 85% of cases occur after the successful surgical intervention on nutritional problems due to a disturbed motility of the distal Ösophagussegments. This poor motility predisposes the child to gastroesophageal reflux. If all medical measures are unsuccessful, may need a Nissen fundoplication performed werden.Behandlungshinweis first Bairdain S, R Ricca, Riehle K, et al: Early results of an objective feedback-directed system for the staged traction repair of long-gap oesophageal atresia. J Pediatr Surg 48 (10): 2027-2031, 2013. doi: 10.1016 / j.jpedsurg.2013.05.008. Key points There are 5 types of esophageal atresia; all but one are associated with a tracheoesophageal fistula. Sometimes the diagnosis of prenatal ultrasound examination is suspected. Clinical findings are excessive secretion, cough and cyanosis after swallowing tests and aspiration pneumonia. The diagnosis is made by inserting a NGT or a nasogastric tube. The treatment consists of elective surgical removal.

Health Life Media Team

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