Isolated esophageal atresia

Case contributed by Dr Chitani Mbewe

Presentation

Baby born at term with a birth weight of 3.2 kg, presents on day 1 of life with excessive oral secretions and poor feeding. Antenatal ultrasound had demonstrated polyhydramnios.

Patient Data

Age: 1 day
Gender: Female
X-ray

Gasless abdomen with no gas in the stomach or bowel loops.

Nasogastric tube in situ, with distal tip curled at the level of the thoracic inlet and no passage of the enteric tube distally.

Bilateral 11 ribs identified.

No associated cardiomegaly, vertebral abnormalities or abnormal pulmonary vascularity.

Case Discussion

Esophageal atresia describes the congenital occlusion of upper esophagus secondary to failure of the primitive foregut to divide into the trachea (anteriorly) and the esophagus (posteriorly). 

Isolated esophageal atresia (8-9%) has no anomalous congenital tracheoesophageal fistulous communication of the esophagus and trachea.
Abdominal radiographs reveal a gasless abdomen devoid of air within the stomach or bowel loops.

Additionally, nasogastric (enteric) tube if inserted, would be curled at the level of the thoracic inlet in a gas-distended proximal esophageal pouch with no passage of the enteric tube seen distally.

It is imperative to look for associated cardiomegaly, vertebral anomalies or abnormal pulmonary vascularity, which may be associated with esophageal atresia.

The side of aortic arch (left vs right) is significant and should be reported (if identifiable) as this influences the approach for surgical repair (i.e. thoracotomy is done opposite to the side of arch).

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