Academic Editor: Divey Manocha
Affilation: Upstate Medical University
Thomas Gibson, is credited for describing the first case of oesophageal atresia (OA) and tracheoesophageal fistula (TEF) and Thomas Hill, noted the second case of OA with an associated anomaly of an imperforate anus. While some newborns may have TEF, about 4% of newborns with TEF do not have OA.
Here we present a case TEF with OA, associated with meconium aspiration syndrome (MAS) in an infant. We aim to highlight the importance of conducting a comprehensive antenatal and prenatal workup in newborns to avoid management difficulties after birth and prevent an avoidable fatality. Also, to highlight an early diagnosis if a baby has respiratory distress and ther is failure to pass nasogastric tube and an X-ray which indicates a coiled tube in esophagus and intestinal air suggesting TEF.
Congenital malformations usually occur during organogenesis resulting in complete or partial absence of an anatomical part or alteration of its normal configuration. Major structural anomalies occur in 2-3% of live births and an additional 2-3% are recognized by the age of 5.
This case report presented has shown TEF with blind ending esophageal pouch with a fistula from trachea o distal esophagus.The pathogenesis is poorly understood; the trachea, oesophagus and lungs are foregut derivatives that divide into ventral respiratory and dorsal oesophageal components. Sometimes the oesophagus fails to separate from trachea leading to TEF.
Mastroiacovo et al
According to Waterston classification our case was type B and according Spitz classification she was falling into category II.
The incidence of other anomalies associated with TEF/OA is reported to be 30-60%.
Sparey et al
In the postnatal period TEF/OA should be considered if newborn has pooling of saliva, feeding and breathing difficulties, and passes nasogastric tube with a pain; however chest x-ray to demonstrate the coiled tube in the esophagus is more confirmatory as was the case in our patient except that she also had Grade 1 MAS. Additional diagnostic modalities include upper pouch esophagogram (UPEG), tracheobronchoscopy and contrast esophagogram with fluoroscopic control. Even endoscopic procedures like bronchoscopy and oesophagoscopy can be used. However, esophagogram with contrast and barium studies offer the best visualization of TEF/OA.
Surgical management includes Neonatal Intensive Care Unit and appropriate anesthesia, which is available in developed countries and has an almost 100% survival rate as compared to low-income settings that exist in countries like ours, where all discipline facilities including prompt surgical intervention, ventilator support and prevention of septicemia are lacking, resulting in a high morbidity and mortality ratio.
The outcome is generally better for term babies
This case highlights the significance of conducting a comprehensive clinical examination in newborns; meticulous prenatal workup is also necessary to reduce fatalities. TEF/OA should be suspected in any newborn presenting with respiratory distress, persistent drooling, a history of polyhydrominos and inability to pass nasogastric tube. Ventilator support and other management modalities should be mandatory in a tertiary care setup. The parents should also be counseled about future pregnancy as it carries a 1% risk of recurrence.
Consent: Written informed consent was obtained from the parents of the baby for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.