ESOPHAGEAL ATRESIA TRACHEAL FISTULAE

Esophageal atresia with and without tracheoesophageal fistulae
This condition rarely is considered a life-threatening emergency; however, early diagnosis is essential to prevent further complication. Because secretions or oral feedings are not capable of passage into the stomach, the contents of the esophageal pouch readily reflux, placing these infants at high risk for aspiration.

A Replogle suction catheter should be inserted to reach the esophageal pouch and placed on low continuous suction as soon as possible. Infants with an associated distal fistula to the trachea are also at high risk for aspiration of gastric contents into the lungs via the gastrobronchial fistula, which most often empties into the airway near the carina.

If at all possible, positive pressure ventilation should be avoided in these infants. Any positive pressure applied to the airway results in inflation of the fistula, stomach, and bowel, which then results in abdominal distention. This distending pressure cannot be relieved by esophageal reflux through the atretic esophagus.

Relief of the distending pressure occurs with reflux of gastric contents into the lungs via the fistula. The continued application of positive pressure ventilation also may lead to massive gastric distention and possible rupture. In rare emergency situations, percutaneous gastrotomy may be required to decompress the stomach; however, controlled surgical placement of a gastrostomy tube is preferable.