Causes
Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges during the third week of embryological development.A fistula, from the Latin meaning ‘a pipe,’ is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-oesophageal fistula it runs between the trachea and the oesophagus. This connection may or may not have a central cavity; if it does, then food within the oesophagus may pass into the trachea (and on to the lungs) or alternatively, air in the trachea may cross into the oesophagus.
Associations
Babies with TEF or EA are unable to feed properly. Once diagnosed, prompt surgery is required to allow the baby to take in food. Many TEF children have few problems after surgery, however a number develop feeding difficulties and chest problems. Some TEF babies are also born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities.
Classification
Fistulae between the trachea and esophagus in the newborn can be of diverse morphology and anatomical location, however, various pediatric surgical publications have attempted a classification system comprised of the below specified types.| Type | Description |
| Type C | Proximal esophageal atresia (esophagus continuous with the mouth ending in a blind loop superior to the sternal angle) with a distal esophagus arising from the lower trachea or carina. (Most common, up to 90% of cases.) |
| Type A | Proximal and distal esophageal bud--a normal esophagus with a missing mid-segment. |
| Type D | Proximal esophageal termination on the lower trachea or carina with distal esophagus arising from the carina. |
| Type H | A variant of type D: if the two segments of esophagus communicate, this is termed an H-type fistula due to its resemblance to the letter H. |
| Type B | Proximal esophageal termination on the lower trachea with distal esophageal bud. |
The letter codes are usually associated with the system used by Gross, while number codes are usually associated with Vogt.
(For the purposes of this discussion, proximal esophagus indicates normal esophageal tissue arising normally from the pharynx, and distal esophagus indicates normal esophageal tissue emptying into the proximal stomach.)
Clinical presentation
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, and cyanosis coincident with the onset of feeding.Treatment
It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Surgical repair is associated with complications, including- Stricture, due to gastric acid erosion of the shortened esophagus.
- Leak of contents at the point of anastomosis.
- Recurrence of fistula.
References
External links
Italic text
This article is licensed under the GNU Free Documentation License.
Last updated on Thursday July 24, 2008 at 01:00:42 PDT (GMT -0700)
View this article at Wikipedia.org - Edit this article at Wikipedia.org - Donate to the Wikimedia Foundation
Causes
Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges during the third week of embryological development.A fistula, from the Latin meaning ‘a pipe,’ is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-oesophageal fistula it runs between the trachea and the oesophagus. This connection may or may not have a central cavity; if it does, then food within the oesophagus may pass into the trachea (and on to the lungs) or alternatively, air in the trachea may cross into the oesophagus.
Associations
Babies with TEF or EA are unable to feed properly. Once diagnosed, prompt surgery is required to allow the baby to take in food. Many TEF children have few problems after surgery, however a number develop feeding difficulties and chest problems. Some TEF babies are also born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities.
Classification
Fistulae between the trachea and esophagus in the newborn can be of diverse morphology and anatomical location, however, various pediatric surgical publications have attempted a classification system comprised of the below specified types.| Type | Description |
| Type C | Proximal esophageal atresia (esophagus continuous with the mouth ending in a blind loop superior to the sternal angle) with a distal esophagus arising from the lower trachea or carina. (Most common, up to 90% of cases.) |
| Type A | Proximal and distal esophageal bud--a normal esophagus with a missing mid-segment. |
| Type D | Proximal esophageal termination on the lower trachea or carina with distal esophagus arising from the carina. |
| Type H | A variant of type D: if the two segments of esophagus communicate, this is termed an H-type fistula due to its resemblance to the letter H. |
| Type B | Proximal esophageal termination on the lower trachea with distal esophageal bud. |
The letter codes are usually associated with the system used by Gross, while number codes are usually associated with Vogt.
(For the purposes of this discussion, proximal esophagus indicates normal esophageal tissue arising normally from the pharynx, and distal esophagus indicates normal esophageal tissue emptying into the proximal stomach.)
Clinical presentation
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, and cyanosis coincident with the onset of feeding.Treatment
It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Surgical repair is associated with complications, including- Stricture, due to gastric acid erosion of the shortened esophagus.
- Leak of contents at the point of anastomosis.
- Recurrence of fistula.
References
External links
Italic text
This article is licensed under the GNU Free Documentation License.
Last updated on Thursday July 24, 2008 at 01:00:42 PDT (GMT -0700)
View this article at Wikipedia.org - Edit this article at Wikipedia.org - Donate to the Wikimedia Foundation
Copyright © 2008, Dictionary.com, LLC. All rights reserved.