Fistula between airway and esophagus

Introduction The fistula between the airway and the esophagus can be congenital or acquired and can be divided into tracheal-esophageal fistula and bronchial-esophageal fistula. Although congenital anomalies are usually found in newborns, the former type can not be diagnosed until adolescents or even adults. Most cases have a history of long-term feeding cough or cough, often coughing out food particles, and occasionally with bronchiectasis. The most common cause of abnormal airway and esophageal traffic is esophageal cancer, and some cases can occur after radiotherapy, with an incidence of about 5.3%. Once this complication occurs, the prognosis is extremely poor and most cases die within weeks or months. Acquired tracheal-esophageal fistula can also be caused by tracheal balloon compression of the trachea, surgical trauma, blunt injury, and foreign bodies. CT examination can be used to confirm the diagnosis of fiberoptic bronchoscopy and swallowing. The treatment mainly relies on surgery, unconditionally tolerate the surgeon, and can be used for medical gel closure therapy.

Cause

The cause of this malformation is unknown. Genetic, environmental and other factors are related to it. However, there are no animal models for research so far, and there have been many family case reports in the literature. Beijing Children's Hospital had two brothers who had type I and III esophageal atresia for more than a year. The twin rate of this disease is 2.5% higher than that of normal abortion. Beijing Children's Hospital has counted 6 of 169 cases (3.5%) as one of the twins.

an examination

Related inspection

Gastrointestinal CT examination Otolaryngology CT examination Fiberoptic bronchoscopy

1. Be alert to excessive amniotic fluid

First of all, you should be alert to this disease, especially when pregnant women with excessive amniotic fluid should exclude all kinds of congenital malformations such as esophageal atresia. Prenatal diagnosis can refer to elevated amniotic fluid, fetal protein and acetylcholinesterase, but it is recognized that B-mode ultrasound is more accurate and non-invasive. The easiest and most convenient is that the obstetrician inserts the suction tube into the stomach in the delivery room to eliminate the disease. X-ray examination was performed immediately when the catheter was blocked. Pediatric surgeons have increased oral saliva in newborn babies, improved after sucking, and recurrent dyspnea symptoms should be suspected and the disease, and immediately with a rubber catheter.

2. X-ray inspection

X-ray examination is decisive for diagnosis. The method is to take 10F new rubber catheter (the lumen can also be filled for observation) to insert the esophagus from the mouth or nostril, and it is blocked at more than 10~12cm. Continue to insert the tube to see the end of the tube. Sometimes it can be The curl is compressed in the proximal esophagus to compress the trachea, and the child has perioral cyanosis and difficulty breathing. At this moment, pull out the 3~4cm catheter and take the chest orthodontic or oblique position. The catheter retraction is the lower edge of the proximal end of the esophagus (the rubber catheter is elastic and slightly higher than the actual level), and is represented by the corresponding thoracic vertebra. If the catheter is located at the upper edge of the chest 4 or the lower edge of the chest 3, it is often LaddIIIb type, indicating that the distance between the two esophagus ends is less than 2cm, and the chance of coincidence in the first phase is large. In the X-ray film, the stomach and intestines are often inflated in type III, and the gastrointestinal insufficiency is almost all type I. Because about 1% of type III is blocked by mucus due to small tube, the stomach is not inflated, and the X-ray is similar to type I. However, the position of the proximal esophage blind end can be lower than the chest level. From the above, a simple intubation film can not only diagnose the esophageal atresia, but also clarify more than 90% of the type. Reports of catheters entering the stomach through the tracheal esophagus are rare. We have seen type III cases of "spit" green fluids through fistulas. Types II, IV and V are rare. Diagnosis is more difficult.

Iodine angiography is often unnecessary. Barium meal inspection is contraindicated, and methylcellulose suspensions of micronized barium sulfate have been reported to be imaged. Diagnostic fistula methods such as active fluorescence photography and endoscopy vary. Umbilical artery angiography or CT can be diagnosed when esophageal atresia combined with right aortic arch.

Other malformations often require imaging examination to confirm the diagnosis.

Differential diagnosis

The fistula between the airway and the esophagus often has the following symptoms and needs to be identified.

1. Too much amniotic fluid: This disease is often accompanied by excessive amniotic fluid in the mother's pregnancy. Cudmore reported 85% of hernia-free and 32% of hernia-type esophageal atresia combined with maternal amniotic fluid. Beijing Children's Hospital from 1955 to 1981, 119 cases of type III (43%) (36.1%), 13 cases of type I (8.5%) combined with polyhydramnios.

2. Low body weight: In 1993, the United States reported that 34% of body weight was less than 2.5kg. In Beijing in 1981, about 1/3 of the cases were born with a body weight of less than 2.5 kg, but only about 1/4 of the cases were premature.

3. With malformation: this disease can be associated with a variety of deformities. Some people use VACTERL to summarize, namely vertebral, anal, cardial, tracheo-asophageal, renal and limb. Foreign statistics are most common in cardiovascular malformations (23.6% to 37%), and urinary systems account for about 20%. In the case statistics of Beijing Children's Hospital, 12% had rectal and anal malformations, followed by spine and limb deformities, each accounting for 8.1%. In 1981, the hospital had 59 malformations in 210 cases, including hemivertebra, rectal anal atresia, anal without rectal vestibular fistula, perineal or urethral fistula, hymen atresia, right heart, ventricular septal defect, abdominal aortic stenosis, Right lung deficiency, horseshoe kidney, horseshoe inversion, sputum thumb, I metacarpophalangeal dislocation, duodenal obstruction, annular pancreas, accessory spleen, megacolon, bilateral thirteen ribs, meningocele, Torticol and external ear malformations. The extensive nature of the deformity demonstrates Stephens' theory that the esophageal atresia combined with malformation is due to general damage to the leaf tissue during the fourth week of pregnancy. At present, the type and severity of combined malformations in China significantly affect parents' attitudes toward treatment, cure rate and evaluation of esophageal atresia.

4. Difficulty breathing: due to esophageal atresia, swallowing saliva and milk juice blocked by reflux reflux, causing pneumonia and atelectasis early in life. In the common type III, high acidity gastric juice is re-introduced into the respiratory tract through the fistula. In addition, the long-term oppression of the proximal esophagus, often accompanied by uncoordinated movement of the esophageal wall muscles, weakened peristalsis, and intrauterine dilatation, can cause respiratory function and aggravate symptoms.

The typical performance is postnatal suffocation and the Apgar score is low. White foamy saliva emerged from the mouth and mouth early in life. Significant cough occurred on the first feeding. The child has difficulty breathing, and the nose fan, mouth and face are blemishes. These symptoms can be improved faster when the milk in the blind end of the proximal esophagus or the thicker yellow-orange mucus is fully absorbed. Soon, the symptoms reappeared. Pneumonia was mixed within a few days after birth and quickly increased, and died in a short time.

5. Other symptoms such as dehydration, normal yellow stool after discharge of the fetus. Symptoms of combined malformations are sometimes obvious, such as cyanosis in congenital heart disease, severe abdominal distension in rectal anus deformity.

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