TRACHEO-ESOPHAGEAL FISTULA

ESOPHAGEAL ATRESIA

Three common anatomic variants:

  1. Interruption of the esophagus in which the upper portion ends in a blind pouch and the lower portion connects to the trachea by a small fistular opening      (3-5mm in diameter).
  2. Complete interruption between the upper and lower esophagus with no connection to the trachea.
  3. Relatively normal esophagus connecting to the trachea by a H-type fistular tract.

                         I – Esophageal atresia without a fistula.

II – Esophageal atresia with a fistula between the proximal pouch and trachea.

III – Esophageal atresia with a fistula from the trachea or main bronchus to the distal esophageal segment (most common type).

IV –Esophageal atresia with both proximal and distal fistulae.

V – H-type tracheoesophageal fistula without atresia (not seen in utero and usually presents with feeding difficulties in infancy).

                      

ULTRASOUND

 

Link to Ultrasound

 

ASSOCIATED ANOMALIES

            The combination of both conditions are associated with several other conditions:

1.      CHARGE association.

2.      VACTERL association with duodenal atresia (3).

3.      Trisomy 21.

4.      Feingold syndrome (oculodigitoesophago-duodenal syndrome) (4):

         -         Microcephaly, tracheo-esophageal fistula and mesobrachyphalangy.

5.  MODED (5): Microcephaly-oculo-digito-esophageal-duodenal syndrome.

 

 

REFERENCES

  1. Grosfield JL, Ballantine TVN. Esophageal atresia and tracheoesophageal fistula: Effect of delayed thoracotomy on survival. Surgery 19878;84:394.
  2. Andrassy RJ, Mahour GH. Gastrointestinal anomalies associated with esophageal atresia or tracheoesophageal fistula. Arch Surg 1979;114(10):1125-1128
  3. Muraji T, Mahour GH. Surgical problems in patients with VATER-associated anomalies. J Pediatr Surg 1984;19(5):550-554.
  4. Courtens W, Levi S, Verbelen F et.al. Feingold syndrome: report of a new family and review. Am J Med Genet 1997;73(1):55-60.
  5. Frydman M, Katz M, Cabot SG et.al. MODED: microcephaly-oculo-digito-esophageal-duodenal syndrome. Am J Med Genet 1997;71(3):251-257.