Oesophageal atresia andor tracheooesophageal fistula

This is one of the most challenging conditions in neonatal surgery. It affects 1 in 4000 live births. The anatomical variations in

CNS causes

Choanal atresia

Micrognathia macroglossia Laryngomalacia Subglottic stenosis Tracheomalacia

Oesophageal atresia : Tracheo-oesophageal fistula

Vascular ring

Cystic lesions of lung

Hyaline membrane disease

Congenital heart disease Pneumothorax

Congenital diaphragmatic hernia Phrenic nerve palsy

Diaphragmatic splinting from increased intra-abdominal pressure

CNS causes

Cystic lesions of lung

Figure 23.1. Major causes of respiratory distress in the newborn.

order of frequency are following:

• proximal oesophageal atresia with distal tracheo-oesophageal fistula (85%);

• pure oesophageal atresia without a fistula (10%);

• H-type tracheo-oesophageal fistula without atresia (4%);

• oesophageal atresia with proximal tracheo-oesophageal fistula (0.5%);

• oesophageal atresia with proximal and distal tracheo-oesophageal fistulae (0.5%) (Fig. 23.2).

There is a high incidence of associated anomalies (50%), the best known of which is the vertebral anal cardiac tracheal eesophageal renal limb (VACTERL) association:

• vertebral anomaly (e.g. hemivertebra, 13th rib);

• anorectal anomaly;

• cardiac anomaly;

• iracheo-oesophageal fistula and oesophageal atresia

• renal and Zimb anomalies (e.g. radial aplasia).

Proximal oesophageal atresia, distal tracheo-oesophageal fistula

Pure oesophageal atresia

H-type tracheo-oesophageal fistula

Proximal oesophageal atresia, distal tracheo-oesophageal fistula

Pure oesophageal atresia

H-type tracheo-oesophageal fistula

Oesophageal atresia, Oesophageal atresia, proximal tracheo-oesophageal double tracheo-oesophageal fistula fistula

Figure 23.2. Anatomical types of oesophageal atresia and tracheo-oesophageal fistula.

The CHARGE syndrome describes:

• choanal atresia;

• retarded growth and development;

• genital hypoplasia;

• ear anomaly with deafness.

The survival rate of this once fatal condition is now much improved but mortality remains substantial in infants with major congenital cardiac anomalies and low birth weight.

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