Esophageal Atresia

Key Features

• Presents in the first hours of life

• Polyhydramnios

• Excessive drooling and secretions; choking with attempted feeding

• Unable to pass an orogastric tube to the stomach

• Characterized by a blind esophageal pouch with or without a fistulous connection between the proximal or distal esophagus and the trachea

• In 85% of infants, the fistula is between the distal esophagus and the airway

• Polyhydramnios is common because of high GI obstruction

• Incidence is approximately 1 in 3000 births

Clinical Findings

• Copious secretions

• Choking

• Cyanosis

• Respiratory distress

Diagnosis

• Confirmed with chest radiograph after careful placement of a nasogastric (NG) tube to the point at which resistance is met

• The tube will be seen radiographically in the blind pouch

• If a tracheoesophageal fistula is present to the distal esophagus, gas will be present in the bowel

• In esophageal atresia without tracheoesophageal fistula, no gas is seen in the bowel

Treatment

• The NG tube in the proximal pouch should be placed on low intermittent suction to drain secretions and prevent aspiration

• The head of the bed should be elevated to prevent reflux of gastric contents through the distal fistula into the lungs

• Intravenous glucose and fluids should be provided and oxygen administered as needed

• Surgery is definitive treatment

  • If the distance is short, the fistula can be ligated and the ends of the esophagus anastomosed

  • If the ends of the esophagus cannot be brought together, the initial surgery is fistula ligation and a feeding gastrostomy

• Echocardiography should be performed prior to surgery to rule out a right-sided aortic arch (for which a left-sided thoracotomy would be preferred)