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04-21-2008, 11:15 AM
m Aetiology:
Embriological failure of oesophageal canalisation in one segment with or without tracheo-oesophageal fistula
mVarieties:

1. Atresia with fistula to the lower segment 85%.
2. Atresia with fistula to the upper segment 2%.
3. Atresia with fistula to both segments 1%.
4. Atresia without fistula 12%.
mDiagnosis:
Excessive salivation & inability of feeding the infant.
Failure of passing a catheter through the oesophagus.
Radiography l Plain X-ray film No gas in the stomach means there is no fistula to the lower segment.
l Lipiodiol injection shows the level of atresia.
mTreatment:
Aim of operation: Surgical establishment of continuity of oesophagus & closure of the fistula.
Technique: Cervical esophagostomy can prevent aspiration of the accumulated saliva and should be carried out when it becomes apparent that the two ends will not join primarily.
* If primary repair is possible circular myotomy may help overcome the gap. Delay operation is beneficial as it allows dilatation of the distal segment by gastroesophageal reflux.
* When the gap is long and primary anastomosis is not possible, the esophagus is replaced by gastric tube or a segment of the colon.
SOURCE: DR. AYMAN SALEM'S BOOK
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