Fistula esophago-tracheal congenital

Fistula esophago-tracheal congenital

Congenital esophageal-tracheal fistula – an absent canal lined with granulation tissue or epithelium and connecting the lumen of the esophagus with the lumen of the trachea; developmental anomaly.

Classification

• • The fistulous course is short and wide (observed most often)
  • The fistula is narrow and long
  • The esophagus and trachea have one common wall throughout.

clinical picture. Clinical symptoms appear in the majority of cases after the first feedings, their intensity depends on the variant of the malformation.

• • Wide and short fistula – feeding a newborn is almost always accompanied by a fit of coughing, cyanosis, foamy discharge from the mouth. Aspiration pneumonia develops rapidly. After eating, the number of wet coarse rales in the lungs increases. Feeding the baby in an upright position reduces the chance of milk flowing through the fistula into the trachea, and coughing occurs less frequently without cyanosis.
  • A narrow and long fistulous tract does not appear in the neonatal period. When eating, mild coughing attacks occasionally appear. Parents traditionally do not attach importance to them, because. feeding the child in a certain position saves him from seizures. Newborns often get pneumonia
  • A large fistula appears at the first meal. Each sip of the liquid triggers a coughing fit. Respiratory failure is prolonged, accompanied by severe cyanosis. The general condition progressively worsens due to severe pneumonia and pulmonary atelectasis.

Special research methods

• • X-ray examination
  • Esophagoscopy. With the introduction of the esophagoscope and examination of the esophagus, the fistulous tract becomes noticeable by the small air bubbles released from it during the breath. A narrow and long fistula is traditionally not visible with esophagoscopy
  • Tracheo-bronchoscopy. At a depth of 7–8 cm, traditionally 2–3 cm higher than the bifurcation of the trachea along its posterior right plane, a slit-like defect is found. Bronchoscopy is facilitated by the introduction of 1% solution of methylene blue into the esophagus.

Treatment:. The only method of treatment is surgery. Preoperative preparation begins immediately after the detection of the tracheoesophageal fistula

• • Feeding through the mouth is completely excluded, a gastric tube is inserted, which is removed after each feeding.
  • From the first day, active anti-pneumonic treatment begins (antibiotics, oxygen therapy, UHF on the chest, intravenous administration of blood products, plasma, vitamins, etc.). Methods of surgical treatment
  • In the presence of a long fistulous passage, the latter is isolated, tied with two ligatures and crossed between them. One row of submersible sutures is placed on the esophagus and trachea
  • With a wide and short fistula, the esophagus is cut off from the trachea and both openings are closed with a 2-row continuous suture, and the esophagus is sutured in the transverse direction
  • When eliminating the esophageal-tracheal fistula, in which both organs have a common wall for some length (traditionally 0.5-0.7 cm), the esophagus is crossed in 2 places. The hole formed on the trachea is sutured, and then the continuity of the esophagus is restored by creating an end-to-end anastomosis.

Postoperative management

• • Active antipneumonic therapy
  • The first 10-12 hours – parenteral nutrition, then feeding through a thin probe left after the operation. The probe is removed for 6-7 days, after the creation of the anastomosis, feeding through the probe is carried out for 9-10 days
  • If a narrowing in the area of ​​the eliminated fistula is detected, a course of bougienage should be carried out no earlier than one month after the surgical intervention.

The prognosis is favorable in case of timely implementation of surgical treatment. ICD. Q39.2 Congenital tracheoesophageal fistula without atresia