Atresia means obstruction. Esophageal atresia (OA) is the absence of an in between the upper and lower parts of the esophagus. The upper and lower sections are unconnected with each other. Therefore, the baby cannot swallow, his saliva, and if fed, the food fills directly into the lungs and the baby suffocates. This anomaly is one of the most important and urgent problems of pediatric surgery. Its incidence is one in 3,000-4,500 live births. The lower esophagus is usually connected to the airway (starting from the airway to the stomach), this is called a Tracheoesophageal fistula (TEF).
It works in a way to lose the air (oxygen) coming into the airway to the stomach with each breath of the baby. For this reason, cyanosis is an important problem as it accompanies heart and great vessel anomalies. There are different types of esophageal atresia, the most common type is a fistula (87%) between the lower esophageal segment and the trachea, and it is briefly expressed as OA + TEF. This is followed by non-fistula type esophageal atresia, the frequency of which varies between 5-10%. In addition, when there is a fistula between the upper esophagus and the trachea, there may or may not be a fistula in the lower esophagus, and the typing continues accordingly.
The type with only tracheaoesophageal fistula without atresia is seen in 4% and is called atresis fistula or H-type fistula.
If the upper esophagus is wide in the ultrasound during pregnancy, esophageal atresia is suspected in the baby. Polyhydramnios is also seen. In the presence of these data, the pregnancy follow-up of the mother, especially in the last months, should be followed up with the obstetrics team in centers with neonatal intensive care and pediatric surgery centers, and delivery should be performed. If esophageal atresia is diagnosed before birth or within the first six hours, the chance of success in treatment is quite high. A newborn born with OA cannot swallow his saliva and it accumulates in the mouth. Babies in this situation should be examined before feeding so that they do not have neonatal pneumonia, so that good results can be obtained from the surgery.
If suffocation occurs while breastfeeding or bottle feeding, and if he or she cannot breathe easily and neonatal pneumonia develops, he/she gets results from antibiotic treatment, but if the complaints start again when the antibiotic is stopped, this indicates H-type fistula and should be investigated immediately in this respect.
Esophageal atresia and concomitant anomalies in anal atresia are very common and the anomalies consist of vertebra, anorectal malformation, cardiac, tracheoesophageal fistula, renal, radial dysplasia and limb (extremity) defects abbreviated as VACTERL.
Diagnosis is made in a newborn baby whose saliva accumulates in the mouth, with the baby’s X-ray showing the contrasted upper pouch taken at this time, when the tube that is tried to be sent from the mouth to the stomach does not go into the stomach. It is repaired by open or closed operation when suitable conditions exist.
