congenital atresia of esophagus : incidence : is a relatively common congenital mal formation...
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Classification : A. Lower segment opens in to the trachea this is the commonest type 85 % of cases. E TTRANSCRIPT
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Congenital atresia of esophagus:
Incidence: Is a relatively common congenital Mal
formation occurring in about one in ( 2500 – 3000 ) life births and usually associated with a tracheoesophageal
fistula.
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Etiology: Remains unknown but the suggested factors are genetic, drugs, infection. The majority of cases are sporadic non – syndromic . group are associated with chromosomal abnormality . Familial / syndromic cases are extremely rare and are less than 1% of total. Associated mal formation are present in about 50% of cases , the most frequent are musculo – skeletal , Cvs , G.1T. , genito – urinary. It is important to be aware of this abnormality , because its recognition within forty – eight hours of birth and subsequent surgical correction , is the only hope of survival .
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Classification: A . Lower segment opens in to the trachea this is the commonest type 85 % of cases.
E T
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B . upper segment opens in to the trachea represent 2.%
B . upper segment opens in to the trachea represent 2.%
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C . Both segments opens in to the trachea this represent 3-5 % of cases.
E T
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D . Both segments end blindly and the mid oesophagus is absent. it represent 3-5 % of cases.
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E . trachea – esophageal fistula without atresia . The so called H – type or N – type, represent 4. %
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Clinical Feature-: The new born baby regurgitates all its first and subsequent feeds . saliva pours, almost continuously from its mouth . this is the sign of oesophageal atresia, it dose not occur in any other condition, attacks of coughing, chocking and cyanosis occur on feeding, sign & symptoms of aspiration pneumonitis may be present. it should be suspected in all cases of hydraminos a condition which is present in 50 % of cases of oesophageal atresia. The diagnosis may be suspected prenatally by the Finding of small or absent fetal stomach bubble on u/s study performed after the (18th) week of gestation.
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A No. ( 10 – 12 ) soft radioopaqe catheter is introduced in to the esophagus through the mouth , should an obstruction encountened about 10 cm. from the lip the diagnosis is practically certain.Contrast study is rarely needed . The diagnosis of H- type fistula is often delayed & may present with history of recurrent pneumonia.
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Surgical inter vention is urgent. Aspiration pneumonia is nearly
always present and antibiotic should be given, dehydration should be corrected, suction catheter is placed in the oesophagheal pouch & patient put in incubator I.V Line and nothing by
mouth .
pre – operative treatment :
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Operative Treatment-: 1 . primary repair : Birth weight, presence of
pneumonia & associated anomelies play major role in determining survival .
2. initial gastrostomy & delaying primary repair specially for those tiny premature babies or those with pneumonia.
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1 . Dysphagia.2 . gastoesophageal reflux .
3 . Stricture.4 . Major anastomotic leak or
disruption.5 . Tracheamalacia.
Post operative complications-:
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Congenital Diaphragmatic Hernia -: Congenital hernia occur at centain well – recognised point due to failure of fusion of the varions elements which make up the diaphragm which includes the septum transversum , pleuro peritoneal membrane, osephageal mesentry, body wall mesoderm, through these points Herniation of an abdominal viscus through the diaphragm in to chest .
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Incidence: - I in every (2000 to 5000 ) life
births. females infant are affected twice as often as males.
Associated anomalies: cardiac , pulmonary hypoplasia, pulmonary vascular abnormalities and
chromosomal abnormalities .
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types1 . postero- lateral diaphragmatic hernia commonly called bochdalek hernia occur in 85 % to 90 % of hernia that seen in neo natal period .2 . Retrosternel hernia ( morgagni ) account for 2-6 % usually occur to the right ) .3 . Hiatus hernia
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Clinical Presentation-: Respiratory distress may be developed immediately after birth, tachypnea, grunting, chest retraction, pallor & cyanosis, scaphoid abdomen, bowel sounds may be present within the chest. intestinal obstruction or bowel ischemia, volulus might be the presenting features.
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Diagnosis - CXR : presence of air and fluid - filled loops of bowel within the chest, mediastinal shift.
-Prenatally by U/S .
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Treatment-: - Resuscitation 02 , NG tube.- IV Fluid, incubator. -Respiratory stabilization and care by ECMO- ( extra corporal membrane oxygenation ) may be needed preoperatively and postoperatively . - Surgical repair.
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Dr. wajdi jalal ali
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