Stomach rupture associated with esophageal atresia, tracheoesophageal fistula, and ventilatory assistance

Tb, Jones; Sg, Kirchner; Fa, Lee; Rm, Heller

doi:10.2214/ajr.134.4.675

Cited by 55 publications

(13 citation statements)

References 5 publications

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“…Ventilatory gases escaping down the distal fistula result in gastric distension which further impedes respiratory function. With progressively increasing gastric distension, the stomach may eventually rupture causing a tension pneumoperitoneum which renders ventilatory support even more difficult [48]. …”

Section: Managementmentioning

confidence: 99%

Oesophageal atresia

Spitz

2007

Orphanet J Rare Dis

423

352

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Oesophageal atresia (OA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheooesophageal fistula, in 7% there is no fistulous connection, while in 4% there is a tracheooesophageal fistula without atresia. OA occurs in 1 in 2500 live births. Infants with OA are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. Associated anomalies occur in 50% of cases, the majority involving one or more of the VACTERL association (vertebral, anorectal, cardiac, tracheooesophageal, renal and limb defects). The aetiology is largely unknown and is likely to be multifactorial, however, various clues have been uncovered in animal experiments particularly defects in the expression of the gene Sonic hedgehog (Shh). The vast majority of cases are sporadic and the recurrence risk for siblings is 1%. The diagnosis may be suspected prenatally by a small or absent stomach bubble on antenatal ultrasound scan at around 18 weeks gestation. The likelihood of an atresia is increased by the presence of polyhydramnios. A nasogastric tube should be passed at birth in all infants born to a mother with polyhydramnios as well as to infants who are excessively mucusy soon after delivery to establish or refute the diagnosis. In OA the tube will not progress beyond 10 cm from the mouth (confirmation is by plain X-ray of the chest and abdomen). Definitive management comprises disconnection of the tracheooesophageal fistula, closure of the tracheal defect and primary anastomosis of the oesophagus. Where there is a "long gap" between the ends of the oesophagus, delayed primary repair should be attempted. Only very rarely will an oesophageal replacement be required. Survival is directly related to birth weight and to the presence of a major cardiac defect. Infants weighing over 1500 g and having no major cardiac problem should have a near 100% survival, while the presence of one of the risk factors reduces survival to 80% and further to 30-50% in the presence of both risk factors.

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Section: Managementmentioning

confidence: 99%

Oesophageal atresia

Spitz

2007

Orphanet J Rare Dis

423

352

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“…Both of our patients with agenesis, however, survived and the single death in our series was caused by gastric perforation, a serious complication in babies with TEM who require ventilatory assistance [12]. The two patients with congenital heart disease, although survivors, suffered greater morbidity with a more protracted postoperative course than most of the other infants.…”

Section: Discussionmentioning

confidence: 63%

A spectrum of bronchopulmonary anomalies associated with tracheoesophageal malformations

1985

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The combination of tracheoesophageal and pulmonary malformations is unusual and reportedly carries a high mortality. We have observed six patients with esophageal atresia and tracheoesophageal fistula and one with a bronchoesophageal fistula who had associated bronchopulmonary anomalies ranging from lobar hypoplasia and agenesis to unilateral pulmonary hypoplasia or agenesis. All of the pulmonary malformations were right-sided. Vertebral or rib anomalies were present in five patients, congenital heart disease in two, imperforate anus in one and one patient had radial aplasia and Pierre Robin syndrome. The bronchopulmonary anomalies complicated the surgical care of tracheoesophageal malformations and required radiologic differentiation from aspiration pneumonia and atelectasis. Six of the seven patients survived. Mortality and morbidity were related to complications and associated cardiac anomalies as well as severity of the lung anomaly.

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“…In 1980, Jones et al 3 described a case series of four patients with EA and TEF complicated by a gastric perforation. All of the patients in their series were premature, low birth weight babies, who required mechanical ventilation to maintain oxygenation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Gastric distention and subsequent perforation has been described in patients with EA and TEF who require assisted ventilation, where the air may be preferentially pushed through the fi stula into the stomach, leading to its dilation and perforation. 2,3 This is a retrospective observational review of neonates with EA and TEF associated with gastric perforation.…”

Section: Introductionmentioning

confidence: 99%