Transcript TrachoEsophagial fistula (TEF) and Esophageal Atresia(EA)

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TrachoEsophagial fistula
(TEF)
f.ghaseminia
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A tracheoesophageal fistula (TEF) is a
congenital or acquired communication
between the trachea and esophagus.
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Pathophysiology of congenital
Remember Embryology:
The esophagus and trachea both
develop from the primitive
foregut. In a 4- to 6-week-old
embryo, the caudal part of the
foregut forms a ventral
diverticulum that evolves into
the trachea.
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The longitudinal tracheoesophageal
fold fuses to form a septum that
divides the foregut into a ventral
laryngotracheal tube and a dorsal
esophagus. The posterior
deviation of the
tracheoesophageal septum
causes incomplete separation of
the esophagus from the
laryngotracheal tube and results
in a TEF.
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5 main categories of congenital
TEFs:
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Clinical presentation:
Depends on the type
1,2,4,5(with EA) copious, fine white frothy bubbles
of mucus in the mouth and nose
can’t be feeded
4,5first feeding may cause sudden arestsudden death
3 (without EA)rattling respiration and episodes of
coughing and choking in association with cyanosis.
abdominal distention may occur secondary to collection of
air in the stomach(atelectasis  respiratory failure)
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Diagnosis of EA
.Insertion of a NG-tube(8-10F) or OG-tube
(10-12F)may show coiling in the
mediastinum of patients.
.Contrast studies are seldom required to
confirm the diagnosis. These studies
have the risk of aspiration pneumonitis
and pulmonary injury
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Diagnosis of TEF
.Presence of air in the gastrointestinal
lumen with Percussion or abdominal
radiography
. Some clinicians prefer direct visualization
by flexible esophagoscopy or
bronchoscopy and assess its exact
location prior to surgery.
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Prenatal diagnosis
Prenatal 3D ultrasounds after 24 weeks
may reveal polyhydramnios, absence of
fluid-filled stomach, small abdomen, and
a distended esophageal pouch
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…Diagnosis
It’s very important to check other
anomalies.
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Main anomalies
Syndrome that can be associated with it 
VACTERL including:
Vertebral anomalies
Anorectal anomalies
Cardiovascular anomalies
TrachoEsophagial fistula
Renal anomalies
Limb anomalies
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treatment
Goals of the initial treatment:
1)Attention to ventilation
2)↓ upper pouch pressure
3)Determine appropriate time for surgery
So:
For ↓ aspiration risk:
1)elevate neonate’s head at least 30º in infant
warmer
continiouse suction132)Use “sump” catheter on
IV AB and electrolyte.
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In premature infants
Use oscillatory ventilation with high
frequency
Gastrostomy may be neededplaced on
the water seal,elevated or Intermittently
be clamped
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surgery
1)Thoracotomy
2)Thoracoscopy  w>2.5 kg, stable,
without anomalies
After surgery: 7,8 days NPO in ICU
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complication
Recurrent TEF
Stenosis
pristaltism problem
Gastroesophagial refluxantireflux
drug/surgery
So follow up is Necessary
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Thank for your attention
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