Definition
Esophageal atresia is a congenital malformation characterized by the incomplete formation of the esophagus. This causes an interruption of this part of the digestive tract, which normally allows the passage of food from the mouth to the stomach.
Furthermore, esophageal atresia is frequently associated with the presence of a fistula which makes persistent communication with the trachea possible.
The causes are not currently known, but probably the origin of this anomaly is multifactorial.
Common anatomical types of esophageal atresia: a) Esophageal atresia with distal tracheoesophageal fistula (86% of cases); b) Isolated esophageal atresia without tracheoesophageal fistula (7% of cases); c) H tracheoesophageal fistula (4% of cases)
In over 90% of cases, esophageal atresia is a problem that can be solved through surgery.
Most common symptoms and signs *
- Cyanosis
- Dysphagia
- Dyspnoea
- Abdominal swelling
- Polyhydramnios
- Hoarseness
- Wheezing breath
- Intense salivation
- Squeal
- tachypnoea
- Cough
Further indications
In esophageal atresia there is an interruption of the continuity of the esophagus, frequently associated with the presence of a tracheo-esophageal fistula. Infants with this malformation are unable to swallow and have excessive salivation.
Other characteristic symptoms of esophageal atresia also include cough and cyanosis resulting from repeated attempts at oral feeding.
The presence of a tracheo-esophageal fistula leads to abdominal swelling, while gastric acid aspiration can cause ab ingestis pneumonia.
The diagnosis of esophageal atresia is almost always post-natal and should be considered in case of impossibility to perform the insertion maneuver of the nasogastric tube.
Sometimes, the presence of this anomaly can be suggested by a routine prenatal ultrasound and by the clinical finding of polydramnios (increase in amniotic fluid).
In about half of the cases, they can be associated with anomalies of other organs or systems, not necessarily serious ones; these concern, in particular, the skeletal, digestive, urogenital and cardiovascular apparatus. In a minority of patients, however, more complex malformative associations are possible (VACTERL / VATER).
A radiopaque tube will allow to locate the site of the atresia through X-rays. In atypical cases, it may be necessary to introduce a small quantity of water-soluble contrast medium to define the exact conformation of the anatomical defect. At birth, the intravenous route is used to nourish the baby and ensure adequate fluid intake.
The therapy consists in the surgical correction of the esophageal atresia, when the general conditions of the newborn are stable. After this operation, feeding difficulties are frequent, due to the poor motility of the distal segment of the esophagus; this condition predisposes the newborn to gastroesophageal reflux.
In this case, if the drug therapy does not produce results, it may be necessary to perform a fundoplication operation according to Nissen, then the upper part of the stomach (gastric fundus) is wrapped around the lower portion of the esophagus.
