Esophageal atresia

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

Links

Related articles

• Vrozené atrézie a stenózy gastrointestinálního traktu: Vrozená hypertrofická stenóza pyloru, Atrézie a stenózy tenkého střeva, Anální a rektální atrézie
• Vrozené vývojové vady dýchací soustavy

References

1. MUNTAU, Ania Carolina. Pediatrie. 4. vydání. Praha : Grada, 2009. s. 358. ISBN 978-80-247-2525-3.
2. ↑ ZEMAN, Miroslav et al. Speciální chirurgie. 2. vyd. Praha: Galén, 2004. s.504 ISBN 80-7262-260-9