Oesophageal atresia

1. Oesophageal Atresia

2. Complete obliteration or
discontinuity of the lumen.
Esophagus divided into a
upper(proximal) & a
lower(distal) pouch
May or may not be associated
with a tracheal fistula

3. Types
A B

4. C D E
Commonest
(90%)

5. Abnormal
pathology
• Blind upper
pouch
• Fistula
between
trachea & distal
Resulting
problems
• Aspiration –
saliva/milk
• Pneumonia
• Distension of
stomach
• Gastroesophage

6. Antenatal history
• polyhydramnios

7. Clinical features
-Antenatal – polyhydramnios
-Drooling of saliva
-if fed, milk regurgitates
-Respiratory distress
-Abdominal distension

8. Diagnosis

9. Pre op Treatment
• Upper pouch suction
• Antibiotics
• Head end elevation to
prevent reflux
• Respiratory support

10. Surgery
• Thoracotomy(Rt.)
Ligation of fistula
Esophageal end to end
anastomosis

11. Surgery
• If gap between the 2
esophageal ends is too much
then we have to divert•Cervical esophagostomy- outlet
for saliva
•Gastrostomy- for feeding
•Esophageal replacement when
the child is about older

12. Prognosis
•Birthweight
•Associated anomalies –
VACTERL
•pneumonia

13. Long term
• Stenosis
• Motility problems

14. CONGENITAL
DIAPHRAGMATIC HERNIA

15. Development of diaphragm
• Septum transversum
• Pleuroperitoneal membrane
• Esophageal mesentery
• Mesoderm of body wall

16. If diaphragm not developed completely
Bowel that is returning into abdominal
cavity enters thoracic cavity
Impaired development of lungs

17. • Can be detected antenatally
• Prognosis is worse if it is diagnosed before
24 weeks, stomach in chest

18. Clinical features
• Respiratory distress- cyanosis, tachpnoea,
tachycardia, sternal retraction
• Scaphoid abdomen
• Pseudo dextrocardia
• Absent breath sounds on left side

19. hypoxia
Pulmonary
vasoconstriction
Pulmonary hypertension
Persistent fetal
circulation (R to L
shunt)

20. Diagnosis

22. Treatment
• Physiological emergency
• May need ventilatory support &
stabilization
• Control pulmonary hypertension

23. Surgical treatment
• Laparotomy & repair of the defect

25. Newer treatment options
• Antenatal – PLUG therapy
• Post natatally – liquid ventilation, high
frequency ventilation