Tracheo Oesophageal Fistula-Classification,History,Diagnosis,Problems

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Trachea oesophageal fistula

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TRACHEO-OESOPHAGEAL FISTULA

Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

HISTORY

Its incidence is about 1/4000. It was first described 1670. Surgical correction was started only in 1920s. The first survivors were reported in 1939. Extrapleural approach was reported in 1941.

EMBRYOLOGY

It occurs between the 21^st and 34^th days of fetal development.

From the Ventral diverticulum of foregut, masses of endodermal cells divide foregut into trachea and oesophagus. It begins at carina and its imperfect division results in TOF.

Explanation of Esophageal Atresia is less clear.

Growth of trachea in caudal direction is so rapid that dorsal wall of oesophagus becomes incorporated into trachea.

Other etiologies: "Vascular deficiency" Genetic basis.

CLASSIFICATION:

Gross divided this in to five groups:

A- Esophageal atresia without fistula

B- Atresia with upper segment communication

C- Atresia with lower segment communication

D- Atresia with both segments communicating

E- Fistula with no disruption in continuity

F- Esophageal stenosis.

PRESENTATION

ANTENATAL

Polyhydramnios

POST-NATAL

Drooling
Respiratory distress
Choking, coughing, cyanosis

DIAGNOSIS

Failure to pass NG tube

Radiographic

Plain
Thin Barium Contrast

Bronchoscopy

ASSOCIATED ANOMALIES: Overall incidence of associated anomalies is 50-70%

Cardiac (30%)

PDA, VSD, ASD

Gastrointestinal (12%)

Imperforate anus, duodenal atresia, annular pancreas, pyloric stenosis

VACTERL (25%)

Waterson Risk Groups and Current Survival Figures

Group	Survival(%)	Waterson classification
A	100	Birth Weight > 2500g, well child
B1	85	Birth Weight 1800-2500g, well child
B2		Higher weight with moderate associated anomalies
C1	65	Birth Weight < 1800g
C2		Birth Weight < 1800g, severe anomalies

PROBLEMS WITH TRACHEO-ESOPHAGEAL FISTULA

General :

Management of neonate
Possible prematurity and low birth weight

Specific :

Aspiration
Chemical pneumonitis, pneumonia
Gastric distention with diaphragmatic splinting

Next : Trachea Oesophageal Fistula(Contd.)

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