Atresia Esophagus

06/02/2017
Introduction
• Tracheo-oesophageal fistula and
Oesophageal Atresia are the
malformation of digestive system, In
which oesophagus does not develop
properly.
• The oesophagus is a tube that
normally carries food from the
mouth to stomach.
DEFINITION EPIDEMIOLOGY
Oesophageal Atresia • Tracheo-oesophageal fistula occurs in 1 in 3500
Oesophageal Atresia is the births, with slight male dominance.
failure of oesophagus to form • Oesophagus atresia with or without Tracheo-
a continuous passage from oesophageal fistula is common in prematurity, with
the pharynx to the stomach. 34% of cases weighing less than 2500 grams.
Tracheo-oesophageal fistula • Approximately 50% of neonates with oesophagus
Tracheo-oesophageal fistula is atresia or Tracheo-oesophageal fistula have other
an abnormal connection anomalies also. Usually cardiac anomalies are seen in
between the trachea and the 14.7 – 28 % cases of TEF.
oesophagus.
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ETIOLOGY PATHOPHYSIOLOGY
• The cause of Tracheo-oesophageal
• The upper part of oesophagus is developed from
the retropharyngeal segment and lower part from
fistula and Oesophageal Atresia is the pregastric segment of foregut.
still unknown. • At about 4 weeks of gestation, a laryngo-tracheal

groove is formed which divides the foregut into
two longitudinal tubes, which further develop into
the respiratory tract and the digestive tract.
• Defective separation due to

deviated or incomplete septum
or incomplete fusion of tracheal
fold results in malformation of
trachea and oesophagus.
TYPES OF TEF Types B:

In this type, Oesophageal Atresia
Type A: is present and the blind proximal
In this type, there is Oesophageal segment of oesophagus connects
Atresia and proximal and distal with trachea by a fistula. The
segments of oesophagus are distal end of oesophagus is blind.
blind. There is no communication This type is present in 0.8 %
between trachea and cases.
oesophagus. This type is present
in 3-7 % of cases.
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Type C: Type D:
In this type, Oesophageal Atresia It is the rarest type that occurs in
is present. The proximal end of 0.7 % cases. In this type, both
oesophagus is a blind pouch and upper and lower segments of
distal segment of oesophagus is oesophagus communicate with
connected by fistula to trachea. trachea.
This is the commonest type,
present in about 87 % cases.
Type E:
In this type, oesophagus and
CLINICAL MANIFESTATIONS
trachea are normal and The disorder is usually detected soon after
completely formed but are birth when feeding is attempted on the
connected by a fistula. This type is basis of following :
also known as ‘H’ type and is 1. Violent response occurs on feeding
present in 4.2% cases.  Infant coughs and chokes
 Fluid returns through nose and mouth.
 Cyanosis occur
 The infant struggles
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Cont.… DIAGNOSTIC EVLUATION

2. Excessive secretions coming out of nose and constant drooling of
saliva. The EA/TEF may be suspected prenatally if
3. Saliva is frothy.  Ultrasound examination reveals polyhydramnios,
4. Abdominal distension occurs in presence of type III, IV and V absence of a fluid-filled stomach, a small abdomen,
fistula. lower-than-expected fetal weight, and a distended
5. Intermittent unexplained cyanosis and laryngospasm, caused by esophageal pouch.
aspiration of accumulated saliva in blind oesophageal pouch.
 Fetal MRI may be used to confirm the presence of
6. Pneumonia may occur due to overflow of milk and saliva from
oesophagus through fistula into the lungs. EA/TEF
TEF may be detected postnatally by

TREATMENT
 X-ray taken with radiopaque catheter placed in
esophagus to check for obstruction; standard
chest X- ray shows a dilated air-filled upper • The management of
esophageal pouch and can demonstrate trachea-oesophageal
pneumonia. fistula is mainly surgical.
 Inability to pass a NG tube into stomach • Surgical intervention
because it meets resistance depends on the distance
between proximal and
distal pouch of
Bronchoscopy visualizes fistula between trachea and esophagus; oesophagus, type of
Abdominal ultrasound and echocardiogram to check for cardiac
abnormalities.
defect, condition of
neonate and his weight.
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 Staging Surgery: When the distance

between the two oesophageal segments
If distance between upper is large and condition of the infant is poor,
a two- stage procedure may be required:
and lower oesophageal
segments is less than 2.5 cm
 Initially in the first stage, the trachea-
and if the condition of oesophageal fistula is ligated and
infant is good, primary gastrostomy done to reduce the risk of
repair is done by division reflux and to provide feeding.
 In the second stage, both proximal and
and ligation of the fistula distal oesophageal segments are
along with end-to-end anastomosed. If the gap is too large, a
anastomosis of proximal segment of colon is used for
reconstruction of the oesophagus. This is
and distal segments of done at about 18-24 months.
oesophagus.
NURSING DIAGNOSIS Post-Operative

Pre-Operative Ineffective airway clearance related
Risk for aspiration related to to disease process.
structural abnormality. Impaired nutrition related to surgery.
Risk for deficient fluid volume related Altered comfort related to surgical
to inability to take oral feeds. process.
Impaired breathing related to
frequent laryngospasm and excessive
secretions in the trachea.
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NURSING INTERVENTION A cervical oesophagostomy

is made to drain out
 A nasogastric tube is put in the upper oesophageal segment and secretions from blind
is aspirated frequently, to prevent collection and aspiration of
secretion into the trachea.
oesophageal pouch and
 Intravenous fluids are administered to maintain the hydration administer oxygen to
status of infant. infant.
 Place the infant in semi-upright position and administer oxygen
Feed the infant orally or by
if cyanosis is present.
gastrostomy.
Position the baby
comfortably in semi-
fowler’s position and
administer analgesics.
COMPLICATION
Tracheomalacia (weakness of tracheal wall)
Anastomotic leak (tension)
Strictures (narrowing, esophageal dilation)
Dysphagia (esophageal motility disorder)
Respiratory distress
Gastro-esophageal reflux.

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06/02/2017

still unknown. • At about 4 weeks of gestation, a laryngo-tracheal

• Defective separation due to

TYPES OF TEF Types B:

Cont.… DIAGNOSTIC EVLUATION

TEF may be detected postnatally by

 Staging Surgery: When the distance

NURSING DIAGNOSIS Post-Operative

NURSING INTERVENTION A cervical oesophagostomy

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