Esophageal Atresia

Alternative names: tracheoesophageal fistula

Definition: Esophageal atresia is a narrowing or obstruction of the esophagus. Tracheoesophageal fistula is a connection or hole between the lower esophagus and the trachea.

Causes, incidence, and risk factors: Esophageal atresia is a disorder of the digestive system that occurs as a congenital anomaly. There are several types of esophageal atresia. In most cases, the upper esophagus ends blindly and does not connect with the lower esophagus and stomach. The top end of the lower esophagus is connected with the trachea (airway to the lungs). This connection or hole between the lower esophagus and the trachea is called an tracheoesophageal fistula.

Over 30% of people affected with this condition will have other abnormalities such as heart disorders or other gastrointestinal tract disorders. This condition is frequently complicated by aspiration of secretions into the lungs, causing pneumonia, choking and the possibility of death and 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 (cyanosis). Immediate surgical repair of this disorder is indicated so that the lungs are not damaged and the baby can be fed. Esophageal atresia and TE fistula occur in approximately 2 or 3 infants per 10,000 births.

Symptoms: excessive salivation, drooling, poor feeding, coughing, gagging and choking associated with attempted feeding, bluish coloration to the skin (cyanosis) associated with attempted feedings, polyhydramnios.

Signs and tests: Excessive amniotic fluid (polyhydramnios) will arouse suspicion of esophageal atresia or other obstruction of the gastrointestinal tract. As soon as the diagnosis is suspected, an attempt to pass a small feeding tube (nasogastric tube) through the mouth or nose into the stomach should be made. Passage of a tube is often done routinely in the delivery room or immediately on arrival at the newborn nursery for several reasons:

  • Detect esophageal atresia
  • Detect choanal atresia
  • Suction excess secretions from the stomach of the newborn infant

An X-ray of the esophagus shows an air filled pouch, and air in the stomach and intestine.

Treatment: Surgical repair of the esophagus is done soon after the infant has been stabilized. Before the surgery, the infant is not fed by mouth, and care is taken to prevent the aspiration of secretions into the lungs.

Expectations (prognosis): Early diagnosis is associated with a better outcome.

Complications: pre maturity may complicate the condition, aspiration pneumonia, feeding difficulties, reflux (the repeated regurgitation of food) is common after surgery.

As with any procedure we perform, your child's safety and well-being our #1 priority. As always, feel free to contact us with any question that you have. We would be happy to answer it for you.