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Esophageal Atresia And Tracheo-Esophageal Fistula

J. Laberge
Published 2011 · Medicine

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Esophageal atresia may be suspected on prenatal sonography by the absence of a gastric bubble, polyhydramnios, and distension of the upper esophagus during swallowing attempts by the fetus. After birth, a child with EA presents with excessive salivation, mucus coming out of the mouth or nose, and noisy breathing with episodes of choking or cyanosis. These symptoms worsen if oral feedings are attempted. The diagnosis is confirmed when a 10F Replogle tube passed through the mouth or nose cannot be passed beyond about 10 cm. Smaller or more flexible catheters should be avoided because they can coil in the upper esophagus and give a false impression of esophageal patency. The tube is placed on suction to clear the excess secretions. An AP and lateral radiograph that includes the neck, chest and abdomen (“babygram”) is then obtained while gentle pressure is maintained on the Replogle and 10 mL of air is injected through it. This delineates very well the location of the upper pouch in relation to the vertebral bodies. Routine contrast studies are not indicated and might lead to aspiration.
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