Tracheoesophageal Fistula Repair

2018 ◽  
Author(s):  
Catherine P. Seipel ◽  
Titilopemi A. O. Aina
Keyword(s):  
Postoperative Analgesia ◽  
Nasogastric Tube ◽  
Tracheoesophageal Fistula ◽  
Imaging Finding ◽  
Anesthetic Management ◽  
Radiographic Imaging ◽  
Fistula Repair ◽  
Live Births ◽  
Vertebral Anomalies ◽  
Esophageal Pouch

Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a congenital malformation occurring in approximately 1:4,000 live births. TEF/EA is characterized by disrupted continuity of the esophagus. There are five distinct types, but the most common is EA with a distal TEF. Most cases are diagnosed postnatally after an inability to pass a nasogastric tube (NGT), with subsequent radiographic imaging finding the NGT coiled within the esophageal pouch. The anesthetic management of TEF/EA repair can be complicated by the presence of cardiac, renal, and vertebral anomalies. Additionally, ventilation can be challenging, and care must be taken to minimize insufflation of the stomach through the fistula. Postoperative analgesia should include consideration of intravenous opioids, nonopioid adjunct medications, and regional and neuraxial techniques.

Intestinal Obstruction in the Newborn

1994 ◽  
Vol 15 (9) ◽  
pp. 338-347 ◽  
Author(s):  
Arthur J. Ross
Keyword(s):  
Intestinal Obstruction ◽  
Newborn Infant ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Clinical Aspects ◽  
Gi Tract ◽  
Live Births ◽  
Esophageal Pouch

Obstruction of an infant's gastrointestinal (GI) tract can occur anywhere from the esophagus to the anus. For purposes of this review, the newborn infant will be defined as an infant from birth to 30 days of age. Both congenital and acquired obstructions will be addressed. In each instance, the epidemiology, pathogenesis, clinical aspects, and management of the disorder will be considered. Esophageal Atresia EPIDEMIOLOGY AND PATHOGENESIS Esophageal atresia, or interruption of the esophagus, generally occurs in association with a tracheoesophageal fistula (EA - TEF). The most common anatomic arrangement is a blind proximal esophageal pouch that has a distal tracheoesophageal fistula (Figure 1). This is seen in 85% to 90% of infants who have this anomaly. Seen less commonly is pure esophageal atresia that does not have a tracheoesophageal fistula and tracheoesophageal fistula that does not have an esophageal atresia (H-type tracheoesophageal fistula). These latter two conditions occur in approximately 10% of newborns who have these types of anomalies. Other anatomic arrangements, such as an esophageal atresia that has a fistula between the upper pouch and trachea or esophageal atresia that has a fistula to both pouches, are seen in only a tiny fraction of these infants. EA - TEF occurs in approximately 1 in 4000 live births.

scholarly journals Case report on Tracheoesophageal Fistula with review of current literature

2017 ◽  
Vol 1 (1) ◽  
pp. 37
Author(s):  
Maria Khan
Keyword(s):  
Respiratory Distress ◽  
Nasogastric Tube ◽  
Tracheoesophageal Fistula ◽  
Antihypertensive Drugs ◽  
Tertiary Care ◽  
Blood Gases ◽  
Severe Respiratory Distress ◽  
Live Births ◽  
Arterial Blood ◽  
Proximal Small Bowel

Major structural anomalies occur in 2-3% of live births all around the World. The reported global incidence of tracheoesophageal fistula (TEF) is roughly 1 in 2,500 live births varying by region. In Pakistan, incidence is reported only by those tertiary care centers that have pediatric surgery facilities available, making it an underreported and often mismanaged condition. We report a case of esophageal atresia (EA),       rectovaginal fistula and tracheoesophageal fistula associated with Meconium Aspiration Syndrome (MAS) in an infant. The baby was 2 days old when she arrived at our center, born at 34 weeks, and weighed 2.3 kilograms. There was no significant   antenatal history except that the mother was on antihypertensive drugs. The baby had an Apgar score of 3 and 4 at 1 and 5 minutes respectively, severe respiratory  distress and cyanosis. Her chest examination revealed subcostal and intercostal   recessions, bilateral crepitation and tachycardia at 180/minute. She was immediately put on ventilator and required frequent suctioning due to excessive secretion,    developed abdominal distension, and had multiple episodes of desaturation and   cyanosis. Complete blood picture showed leukocytosis and arterial blood gases   signifying metabolic acidosis. Upon trying to pass to a catheter, baby passed stool through vagina. Contrast esophagogram showed evidence of distended stomach and proximal small bowel loops. No evidence of air was seen in the rectum. On passing the nasogastric tube into the esophagus, it curled on itself at D4 level with evidence of blind-ending proximal esophageal pouch that dilated with contrast medium. On 10th day of life baby’s condition deteriorated despite all efforts. Eventually she stopped breathing, her pupils dilated and all efforts to resuscitate her failed. This report  highlights the importance of thorough clinical examination and availability of support facilities in a pediatric unit. TEF/EA should be suspected in any newborn who   presents with respiratory distress, drooling, history of polyhydramnios with an    inability to pass nasogastric tube. The parents should also be counselled as TEF/EA carries a 1% risk of recurrence.

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

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