Esophageal Atresia And Tracheo-Esophageal Fistula (TEF)
0 Frequency is 2.5/10000 live births and M/F: 1.06.
0 The incidence of polyhydramnios and prematurity is common in esophageal atresia.
0 Fetoprotein and acetylcholinesterase levels are high in the amniotic fluid of mothers.
0 It accompanies 30-60% additional anomalies and the most common accompanying cardiovascular system anomalies (VSD, ASD, PDA, tetralogy of Fallot, aortic coartation, vascular ring)
0 Later on, anomalies of the gastrointestinal system, genitourinary system, skeletal system and central nervous system are followed, respectively.
0 While additional anomaly is least in isolated TEF cases, it is most common in isolated esophageal atresia.
0 Anorectal malformations are the most common gastrointestinal system anomalies.
0 VATER syndrome; Vertebral and vascular, Anal, Tracheo-esophageal, Radial and renal anomalies and if this syndrome is accompanied by cardiac (Cardiac) and extremity (Limb) anomalies, VACTERL syndrome occurs.
0 Cardiac anomalies are present in up to 80% of VACTERL cases and it is the most common cause of death.
0 CHARGE syndrome; Colobama, heart disease, choanal Atresia, Mental Retardation, Genital hypoplasia, ear anomalies and deafness.
It is examined in five groups:
1. Esophageal atresia + distal TEF (85% - MOST COMMON)
2. Isolated esophageal atresia
3. Esophageal atresia + proximal TEF
4. Esophageal atresia + distal and proximal TEF
5. Isolated TEF (H type)
0 The most common are esophageal atresia and distal TEF. The proximal esophagus is dilated and usually terminates at the third thoracic vertebra.
The distal and narrower esophagus opens into the trachea as a fistula.
0 The most important factor determining the prognosis is the grade of the lung problem and the presence of additional anomalies.
Clinic and Diagnosis
• There is no feeding, pneumonia and respiratory distress due to the passage of gastric secretion to the lungs through fistula.
• Another cause of respiratory distress is the presence of tracheomalacia.
• The first symptom is the saliva that cannot be swallowed from the mouth and nose in the form of foam (soap bubbles).
• Cough, dyspnea and cyanosis may be seen.
• Bronchial secretions may be bloody and bile-stained due to stomach acid.
• Aspiration and associated cough or cyanosis are typical in the first feeding.
• Sudden deaths may occur due to aspiration.
• Fever or hypothermia, tachycardia and change in baby's color are signs of sepsis.
• Pneumonia and atelectasis due to aspiration are common in the right lung.
• In cases with distal TEF, there is abdominal distension due to air passing into the stomach.
• There is polyhydramnios and small gastric chamber in prenatal ultrasonography.
• The prognosis of those with antenatal diagnosis is worse than those with postnatal diagnosis. The most important reason is that they are also trisomy 18.
• While trying to advance the nasogastric tube to the stomach, it is stuck around 10 cm and does not advance.
• X-rays involving the lungs and abdomen are helpful in diagnosis.
• In differential diagnosis; pharyngeal pseudodiverticula and laryngo-tracheo-esophageal clefts are important.
• Half of babies with isolated esophageal atresia are premature, 10-20% have Down syndrome and tracheomalacia.
• The baby is placed in the Semi-Fowler position and the proximal esophagus is continuously aspirated with a double lumen catheter.
Treatment
• Its treatment is surgical and there are early and late complications.
• In the early period; There may be anastomotic leakage, anastomotic stenosis and pulmonary complications.
• In the late period, gastroesophageal reflux, dysphagia and tracheomalacia may occur.