Symptoms
There are certain prenatal (before birth) and postnatal (after birth) signs and symptoms that indicate the presence of esophageal atresia. Before birth, a so-called polyhydramnion, an above-average amount of amniotic fluid, appears. This is due to the fact that the fetus cannot swallow the amniotic fluid because of the malformation.
However, this is an unspecific sign and does not necessarily indicate the presence of esophageal atresia. The affected babies are usually premature babies, who are conspicuous after birth by coughing fits and increased salivation. The saliva runs out of the mouth and collects foamy in front of it.
It cannot be swallowed. A choking out of the foamy saliva is also typical. The general condition of the babies is also worse.
A rattling breathing is often heard. Furthermore, the babies are conspicuous by cyanosis, especially during a feeding attempt. The cyanosis manifests itself by a blue coloration of the skin and mucous membranes, which is caused by the fact that the food does not reach the stomach but is aspirated into the lungs.
This hinders the breathing of the children. Feeding should not be attempted if esophageal atresia is suspected. An attempt should be made to place a stomach tube.
However, the placement of the gastric tube is not successful due to the malformation. In the case of a type IV esophageal atresia according to Vogt, infants suffer from repeated aspiration pneumonia without showing further symptoms. Aspiration pneumonia is pneumonia caused by the repeated inhalation of food residues.
Surgical treatment of esophageal atresia
Surgical therapy is the obligatory measure in the presence of esophageal atresia. The operation is not an emergency operation, but is performed within the first 48 hours after birth. An exception is the respiratory distress syndrome or a massive over-inflation of the stomach with the danger of rupture (tearing of an organ).
In this case, surgery is performed immediately. Delay of the primary surgery is possible in case of very low birth weight or instability of the child.The primary goal of surgery is to restore a continuous esophagus, as well as to close an esophagotracheal fistula, if present. The procedure chosen depends on the type of malformation.
Access is usually via a small right-sided vertical incision in the right axilla. If there is not a large distance between the malformed sections of the esophagus, the two ends of the holhorgan can be connected via an end-to-end anastomosis. This means that the two ends are connected with a suture.
If there is a very large distance between the ends or the length of the esophagus is too short, the organ can be replaced by an organ elevator. For example, the stomach can be pulled up and connected to the rest of the esophagus so that a functional esophagus can be simulated. Stretching techniques and the natural growth of the esophagus are also used to achieve a sufficient length of the esophagus.
To bridge the time until the final surgical appointment, the newborn is then given a so-called salivary fistula. This is an artificial stomach outlet. If there is a fistula formation to the trachea, it must be cut and closed surgically, otherwise oesophageal remains can enter the lungs.
This would lead to permanent pneumonia and destruction of the lungs. After the operation, intensive medical care is provided. The children are usually ventilated for about 2 to 3 days after the operation.
Depending on the course of the operation, they are then fed relatively quickly (also after 2 to 3 days) via the stomach tube. After about 10 to 12 days, a contrast medium examination is performed to assess the success of the operation. If the operation is proceeding well, the child will now be fed orally.
