Tracheoesophageal Atresia and Fistula

Overview

The tube that connects the mouth to the stomach is the esophagus. It is this tube also where the food passes. Another tube adjacent to the esophagus directs not the food but the inhaled air to the lungs. This is known as the trachea or the windpipe. By the third and fourth week intrauterine life, the laryngotracheal groove would develop into the larynx, the trachea and this will be the beginning of the development of the lung tissue. Parallel to these structures is the area where the esophageal lumen forms. In cases where the pregnant mother has been taking teratogens, the separation of the trachea and esophagus would be prevented and a certain number of anomalies might occur.

Esophageal Atresia

Esophageal atresia is present when the upper portion of the esophagus fails to connect with the lower esophagus and the stomach. The word atresia literally means that there is an absent of a normal opening. In this case, the liquid that the baby normally swallows cannot pass through the esophagus and fails to reach the stomach and intestines for digestion and absorption.

Tracheoesophageal Fistula

The word fistula literally means an abnormal passage from a body organ to the body surface or between two internal organs. In tracheoesophageal fistula there is an abnormal connection between the esophagus and the trachea. This abnormality is tube structure is also known as TE fisutula or TEF. An infant with a tracheosophageal fistula will most likely direct swallowed liquid into the lungs as the fluid passes through the abnormal connection between the esophagus and the trachea.

Frequency

About one in 3,000 babies is born with one or both of these problems.

Clinical Manifestations

  • Frothy white bubbles in the infants oral cavity
  • Presence of coughing or choking when feeding
  • Regurgitation or vomiting
  • Cyanosis or the bluish color of the skin especially when feeding the infant
  • Breathing difficulty
  • Full and rounded abdomen

Diagnosis

  • passing a catheter through the infant’s esophagus to the stomach
  • aspiration of stomach contents – positive when stomach contents cannot be aspirated
  • flat plate x-ray of the abdomen
  • barium swallow or bronchial endoscopy

Management

  • Emergency surgery – to prevent the development of pneumonia from leakage of stomach secretions into the lings or dehydration or an electrolyte imbalance from lack of oral intake
  • Gastrostomy – performed under local anesthesia to keep the stomach empty of secretions and prevent reflux into the lungs.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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