Esophageal atresia with tracheoesophageal fistula: Symptoms, Diagnosis & Treatments
Esophageal atresia is the most common anomaly occurring in esophagus, with an incidence of 1.7 per 10,000 births, with more than 90 percent of these occurring with the tracheoesophageal fistula. The most common form of Esophageal atresia is type C, in which the upper esophagus is blocked and the TEF is connected to the distal esophagus. The cause is unknown, but known risk factors include advanced maternal age, obesity, low socioeconomic status, and tobacco smoking. If early detection and appropriate treatment are performed, the survival rate is more than 90 percent. The mortality rate is increased when birth weight is less than 1500g or when severe cardiac anomaly is accompanied. Fifty percent of patients are born without another anomaly, but there are other anomalies associated with the remainder. The most common case is Esophageal atresia, which is a serious complication of VACTERL syndrome. Cardiac and vertebral anomalies were 32% and 24%, respectively.
Symptoms
Patients born with Esophageal atresia have symptoms of cough, cyanosis, and respiratory distress with bubbles in their nose and mouth during birth. Food intake can aggravate these symptoms and induce aspiration to cause pneumonitis.
Early in the onset of respiratory distress, esophageal atresia can be suspected if the nasogastric tube does not pass well into the esophagus. If the stomach air is not visible in the radiologic examination, the presence of polyhydramnios also indicates the possibility of esophageal atresia. After inserting the feeding tube, x-ray can be taken to show the esophageal atresia when the twisted tube is seen, and the TEF that exists together with the stomach can be confirmed through the airy appearance.
Treatments
Prior to surgery, securing the airway and decompressing the proximal pouch are important to prevent aspiration, and antibiotics should be used to prevent pneumonia. Surgical ligation of TEF using right-sided thoracostomy and end-to-end anastomosis of esophagus is the current standard surgical procedure. If the distance between the esophagus where Atresia occurs is more than 3-4 cm, a neureophagus is made using jejunum and colon because primary repair is impossible. The long-term outcome of thoracoscopic surgical repair is known to be good.
Symptoms
Patients born with Esophageal atresia have symptoms of cough, cyanosis, and respiratory distress with bubbles in their nose and mouth during birth. Food intake can aggravate these symptoms and induce aspiration to cause pneumonitis.
Early in the onset of respiratory distress, esophageal atresia can be suspected if the nasogastric tube does not pass well into the esophagus. If the stomach air is not visible in the radiologic examination, the presence of polyhydramnios also indicates the possibility of esophageal atresia. After inserting the feeding tube, x-ray can be taken to show the esophageal atresia when the twisted tube is seen, and the TEF that exists together with the stomach can be confirmed through the airy appearance.
Treatments
Prior to surgery, securing the airway and decompressing the proximal pouch are important to prevent aspiration, and antibiotics should be used to prevent pneumonia. Surgical ligation of TEF using right-sided thoracostomy and end-to-end anastomosis of esophagus is the current standard surgical procedure. If the distance between the esophagus where Atresia occurs is more than 3-4 cm, a neureophagus is made using jejunum and colon because primary repair is impossible. The long-term outcome of thoracoscopic surgical repair is known to be good.
