TEF Tracheoesophageal Fistula

Esophageal atresia is a disorder of the digestive system, in which the esophagus does not develop properly. The disorder is a congenital defect, which means it occurs before birth. There are several types of esophageal atresia.

Causes, incidence, and risk factors:

The esophagus is the tube that normally carries food from the mouth to the stomach. In most cases of esophageal atresia, the upper esophagus ends and does not connect with the lower esophagus and stomach. In these cases, the top end of the lower esophagus is connected to the windpipe. This connection is called a tracheoesophageal fistula (often abbreviated TEF).
Over 30% of people affected by this condition will also have other abnormalities, such as heart disorders or other digestive tract disorders. Other types of esophageal atresia involve narrowing of the esophagus, and may also be associated with other birth defects.
This condition is frequently complicated by the infant's breathing saliva and secretions into the lungs, causing pneumonia, choking, and possibly death. It is considered a surgical emergency.
The disorder is usually detected shortly after birth when feeding is attempted and the infant coughs, chokes, and turns blue. Immediate surgical repair of this disorder is required so that the lungs are not damaged and the baby can be fed.

Symptoms:

  • Drooling
  • Poor feeding
  • Coughing, gagging, and choking with attempted feeding
  • Cyanosis with attempted feedings
  • Too much amniotic fluid during pregnancy

Signs and tests:

Prior to birth, the presence of too much amniotic fluid will cause suspicion of esophageal atresia, or other obstruction of the digestive tract.
After birth, as soon as the diagnosis is suspected, an attempt to pass a small feeding tube through the mouth or nose into the stomach should be made. The feeding tube will not be able to pass all the way to the stomach in a baby with esophageal atresia.
An x-ray of the esophagus shows an air-filled pouch and air in the stomach and intestine. If a feeding tube was passed it will be seen coiled up in the upper esophagus.

Treatment:

Surgery to repair the esophagus is done quickly after the baby has been stabilized. Before the surgery, the baby is not fed by mouth, and care is taken to prevent the baby from breathing secretions into the lungs.

Expectations (prognosis):

An early diagnosis gives a better chance of a good outcome.

Complications:

  • Prematurity may complicate the condition
  • Aspiration Pneumonia
  • Feeding difficulties
  • Reflux (the repeated bringing up of food from the stomach) is common after surgery
 
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