IS Case 358: Esophageal atresia with post op complications after anastomosis


2009 URMC Imaging Sciences
Publication Date: 2010-03-01

History

Patient is a newborn male presenting with dyspnea. House staff are also unable to pass an enteric tube.

Findings

Findings consistent with esophageal atresia.

Diagnosis

Esophageal atresia with post op complications after anastomosis

Discussion

Esophageal atresia (EA) is a congenital developmental disorder of the esophagus which is usually associated with tracheoesophageal (TE) fistula but can occur without. Below is the Gross classification of TE anomalies and their frequency of occurrence:

A. EA with distal TE fistula 82%

B. EA with no fistula 9%

C. H-fistula with no EA 6%

D. EA with proximal and distal fistula 2%

E. EA with proximal fistula 1%

TE fistula or EA are often associated with other anomalies according to the VACTERL association:

V Vertebral anomalies

A Anal atresia

C Cardiac malformation

TE TE fistula or EA

R Renal anomalies

L Limb malformation

The case above is an example of a Gross type B anomaly with no fistula. EA without TE fistula is often associated with trisomy 21. Patients typically present with esophageal obstruction by means of copious oral secretions, cough, and choking episodes which may result in aspiration pneumonia.

Imaging can show an absent stomach bubble, polyhydramnios, and pouch sign at the atretic point in the esophagus during intrauterine ultrasound. A plain radiograph after the patient is born usually shows absent stomach bubble and bowel gas since there is no esophageal communication with the stomach. Also, an enteric tube passed to the esophageal pouch is helpful in delineating the atretic point. Fluoroscopy is rarely needed for diagnosis but is useful to evaluate the esophagus post anastomosis.

Immediate treatment includes pouch suction and head elevation which can then be followed by esophageal lengthening and anastomosis. Short term complications can include esophageal leaks and fistulas, while esophageal dysmotility, GERD, strictures, aspiration, and tracheomalacia can be seen in the long term.

References

  1. Achildi O, Grewal H. Congenital anomalies of the esophagus. Otolaryngol Clin North Am. 2007 Feb;40(1):219-44, viii. PMID: 17346569
  2. Kovesi T, Rubin S. Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest. 2004 Sep;126(3):915-25.PMID: 15364774
  3. Stringer MD, McKenna KM, Goldstein RB, Filly RA, Adzick NS, Harrison MR. Prenatal diagnosis of esophageal atresia. J Pediatr Surg. 1995 Sep;30(9):1258-63. PMID: 8523220

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