There are some unfortunate babies who foam at the mouth all the time after birth, choke and cough when they drink milk, and even have difficulty breathing.
Why?
They often suffer from "esophageal atresia".
1. What is esophageal atresia?
Congenital esophageal atresia (Congenital esophageal atresia, CEA) is a serious congenital malformation, with an incidence rate of about 1/3000 to 1/4500, accounting for the third place in digestive tract developmental malformations (second only to anorectal malformations and Hirschsprung disease ).
Surgery is the only way to cure the disease. With the development of modern medical technology, the current mortality rate is about 8%.
Before understanding esophageal atresia, you must first understand the concept of "esophagus".
What is the esophagus? We all know that the stomach is the organ that digests food, and the esophagus is the tube that connects the mouth to the stomach.
What is esophageal atresia? In layman's terms, it means that the upper and lower esophagus are not connected. After food reaches the upper esophagus, it cannot continue to pass into the lower esophagus.
Esophageal atresia is often accompanied by esophageal-tracheal fistula. In normal people, the esophagus and trachea are two separate tubes, but in children with esophageal atresia, there are often abnormal passages between their esophagus and trachea. A clear diagnosis must be made before surgery. The surgery must not only connect the upper and lower esophagus, but also sew up the abnormal passage between the esophagus and the trachea - otherwise, food will leak into the trachea after eating, causing complications such as pneumonia and atelectasis. Syndrome .
2. Why does esophageal atresia occur?
When the baby is still a small embryo, the esophagus and trachea develop together from scratch.
They all develop from an embryonic structure called the foregut.
The usual rule is that the side walls of the foregut are folded in to form the trachea-esophageal septum , which separates the esophagus and trachea, which were originally the same tube.
If the trachea-esophageal septum is underdeveloped and fails to completely separate the trachea and esophagus, it will lead to esophageal-tracheal fistula.
If the lateral wall of the foregut turns dorsally during development, the esophageal lumen will be cut off, forming esophageal atresia.
In the final analysis, it’s all fate that manipulates people!
3. What are the types of esophageal atresia?
According to the location of esophageal atresia and the condition of esophageal-tracheal fistula, Gross classification standard is currently used in most clinical practice, and esophageal atresia is divided into 5 types.
Type III esophageal atresia is the most common clinically
4. How to diagnose esophageal atresia?
1. Clinical symptoms
Newborns with esophageal atresia often foam at the mouth after birth, vomiting, choking, and even cyanosis and progressive dyspnea after every breastfeeding.
Gastric tube usually cannot be successfully inserted into the stomach and will be damaged in the upper esophagus.
2, Gastrointestinal tract angiography
Gastrointestinal tract angiography Gastrointestinal tract angiography is the simplest and fastest way to diagnose esophageal atresia, and can usually basically clarify the classification of esophageal atresia.
A small amount of contrast agent is injected through the gastric tube. The contrast agent concentrates in the upper esophagus without descending into the stomach, and the diagnosis can be confirmed.
Based on whether there is gas in the stomach and intestines, it can be determined whether the lower esophagus is connected to the trachea.
Type III esophageal atresia
Based on whether the trachea is visualized, it is judged whether the upper esophagus is connected to the trachea.
Type II esophageal atresia
3, CT
CT can do
①Display the location of the proximal end of the atretic esophagus
Type I esophageal atresia
Type I esophageal atresia
②Display the location of the esophageal-tracheal fistula
Ⅱ Type III esophageal atresia
③ Measure the distance between the two blind ends of the esophagus (Type III esophageal atresia , the distance between two blind ends >2cm is type IIIa, and ≤2cm is Ⅲb type )
Ⅲa type esophageal atresia
Ⅲb type esophageal atresia
④Measure the diameter of esophageal-tracheal fistula
⑤Determine whether there is tracheal and bronchial stenosis
⑥Evaluate the lung condition
⑦ Observe the heart, thoracic spine and lungs for other malformations
5. Is esophageal atresia serious?
The severity of esophageal atresia mainly depends on two aspects.
The first aspect is to see if there are malformations combined with other systems, such as anal atresia , congenital heart disease , pulmonary airway malformations, etc.
On the other hand, it mainly depends on the distance between the upper and lower ends of the esophagus. If the distance exceeds 3cm, it will be very difficult to reconstruct the esophagus.
It mainly depends on luck! The more combined deformities there are, the more serious the deformities are, and the longer the distance between the blind end of the esophagus, the more difficult the operation will be!
6. How to treat esophageal atresia?
Surgery is the only way to cure esophageal atresia.
There are two purposes of surgery, one is to reconstruct the esophagus, and the other is to repair the esophagotracheal fistula.
With the advancement of surgeons' surgical skills, operations can often be completed through minimally invasive methods through thoracoscopy .
7. What are the complications after esophageal atresia surgery?
Short-term complications: pneumonia, atelectasis, pneumothorax.
Pneumonia, atelectasis, pneumothorax
Long-term complications: anastomotic fistula, anastomotic stenosis.
Anastomotic stricture
Anastomotic fistula
Anastomotic stricture can be treated by balloon dilation.
Interventional balloon dilatation treatment of anastomotic stricture
8. Can esophageal atresia be detected before birth?
Yes, but it requires ultrasound doctors to have relatively high examination skills and professional sensitivity. The main manifestations are small gastric bubbles and polyhydramnios.
Prenatal Ultrasound: Small Gastric Bubbles
Fetal magnetic resonance also has the potential to diagnose esophageal atresia prenatally, and can even directly display the dilated upper esophagus.
Fetal magnetic resonance imaging: small gastric alveoli and abundant amniotic fluid
Fetal magnetic resonance imaging directly shows dilation of the upper esophageal segment
9. Summary
Esophageal atresia is a rare congenital malformation that is difficult to detect during the fetal period, but it is not impossible— — Mainly through prenatal
Surgical treatment must be received after birth.
Preoperative gastrointestinal angiography and CT examination can confirm the diagnosis and formulate a surgical plan.
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