Congenital fistulas of the esophagus arise as a result of incomplete cleavage of the primary intestinal tube on the esophagus and trachea.
Clinical symptoms
Clinical symptoms appear several hours after the birth of the baby at the first meals. They are determined by a variant of esophageal flaw. In cases of a common wall of the esophagus and trachea, as well as a short and wide fistulous course immediately after each pharynx of food, which causes severe breathing disorders, sequentially, and hypoxia. Cyanosis appears. In the subsequent there is a fasting of food and pneumonia develops. The paroxysmal cough is less pronounced when fed through a probe. At the same time, food does not have access to airborne paths.
In cases of a long and narrow fistulous course in children of the first weeks of life, coughing though it appears, but weakly expressed. Coughing spells are rare. However, at the end of the end, even small amounts of food fall into the respiratory tract, due to which coughing attacks become heavier, respiratory failure increases, and escapes pneumonia.
The most informative for diagnosing fistula of the esophagus is esophagoscopy and itraheobronchoscopy. With the help of esophagoscopy, one can see the entrance hole of the oviposition and the appearance of air bubbles in the esophagus in the region of this hole, as well as frothy mucus. With the help of tracheobronchoscopy, the ingestion (leakage) through the fistula in the respiratory tract of small amounts of food is detected, irritation of the mucous membrane of the trachea or bronchus at the exit site of the fistula. A colorful method is also used to detect the communication of the esophagus with the respiratory tract through the fistulous course. To do this, tint the liquid used by the baby for drinking, methylene blue. The appearance of paint in the respiratory tract confirms the presence of fistula.
Both esophagoscopy and tracheobronchoscopy are performed under general anesthesia.
As for the radiological diagnosis of the esophageal fistula, it has a relative diagnostic significance. Firstly, because the study using contrast medium introduced into the esophagus, and then entering the fistula through inhalation, leads to the development of severe aspiration pneumonia (in the presence of pneumonia, contrast testing is contraindicated). Secondly, the study without a contrast agent practically does not reveal a fistula. There is an indirect method for diagnosing esophageal tracheal-bronchial fistulas, which is a comparison of clinical symptoms of respiratory failure and a state of lungs. To do this, X-ray examination of the lungs. In the absence of signs of inflammatory changes in the lung tissue in the case of cough, the development of respiratory failure in young children, one can think of the presence of esophagus fistula. If the child has already developed aspiration pneumonia, then, this diagnostic method does not really matter. Thus, the X-ray examination should be carried out carefully, bearing in mind the above.
Treatment
The treatment of the esophagus is surgical. Timely surgical treatment cures the patient. In late operative treatment, the prognosis is determined by the character and duration of bronchopulmonary complications.
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