Topics Discussed: anus, imperforate; duodenal obstruction; enterocolitis, necrotizing; esophageal atresia; gastroenterology and hepatology; gastrointestinal obstruction; intestinal obstruction; neonatal intestinal obstruction; tracheoesophageal fistula.
Excerpt:"Definition. Type C tracheoesophageal (TE) fistula is the most common type of esophageal atresia (85%). The esophagus ends blindly ~1012 cm from the nares and the distal esophagus communicates with the posterior trachea (distal tracheoesophageal fistula [TEF]). Type A "pure" esophageal atresia has a similar presentation without the distal gastrointestinal air. This implies esophageal atresia without TEF (10% of cases).
Pathophysiology. Prime morbidity is pulmonary. Complete esophageal obstruction results in inability of the infant to handle his or her own secretions, producing "excess salivation" and aspiration of pharyngeal contents. More important, the direct communication between the stomach and the tracheobronchial tree via the distal TEF allows the crying newborn to greatly distend the stomach with air; impairment of diaphragmatic excursion promotes basilar atelectasis and subsequent pneumonia. Additionally, the distal TEF permits reflux of gastric secretions directly into the tracheobronchial tree, causing chemical pneumonitis, which may be complicated by bacterial pneumonia.
Clinical presentation. The pregnancy may have been complicated by polyhydramnios. After delivery, the infant typically is unable to swallow saliva, which drains from the corners of the mouth and requires frequent suctioning. Attempts at feeding result in prompt regurgitation, coughing, choking, and cyanosis.
Diagnosis. It is..."
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