Esophageal atresia

Esophageal atresia is a birth defect affecting the oesophagus which ends in a blind-ended pouch and is ofter connected through a fistula with the trachea (up to 85 % of cases), which makes the risk of aspiration very high. The incidence is 1:2000 to 1:4000, males and females are affected equally.

Aetiology

 * the defect of the differentiation of primary embryonic gut tube to esophagus, trachea and lung
 * it can linked to VACTERL association – the acronym says: Vertebral anomalies, Anal atresia, Cardiovascular anomalies, Tracheoesophageal fistula, Esophageal atresia, Renal and/or Radial anomalies, Limb defects

Classification

 * 1) according to Vogt (I–III) :
 * 2) *type I: complete absence of the esophagus or instead of esophagus there is a fibrous band,<1%
 * 3) *type II: two esophageal blind pouches, no fistula is present, 8%
 * 4) *type IIIa: The upper esophageal fisitula (the pouch connects abnormally to the trachea). The lower esophageal pouch ends blindly 1%
 * 5) *type IIIb: The lower esophageal fisitula (the pouch connects abnormally to the trachea). The upper esophageal pouch ends blindly; the most common (85-90%)
 * 6) *type IIIc: Both the upper and lower esophageal pouch make a fistula 1%
 * 7) *H-fistula: esophagus is passalbe, fustula is present in the H shape between esophagus and trachea 5%
 * 8) according to R. E. Grosse (A–E/H)

Clinical presentation

 * prenatal period: polyhydramnios (and with that associated risk of preterm labor)
 * postnatal period: excessive salivation, coughing, cyanosis and aspiration during the first feed

Diagnostics

 * we cannot introduce gastric probe
 * X-ray of the abdomen and thorax
 * contrast esophageal X-ray examination – injection of contrast fluid by probe to esophageal pouch, which is the moct common type of atresia - Vogt IIIb ending blindly on the Th 2–4 level.

Treatment

 * surgical closure of tracheoesofageal fistula– as soon as possible after delivery (because of the danger of aspiration)

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