Atresia of the esophagus: causes, symptoms and treatment
Atresia of the esophagus is a severe malformation characterized by the blind end of the upper segment of this part of the alimentary canal. Often this pathology is combined with other malformations. In 5% of cases, it occurs in chromosomal diseases.
How is it detected? What are the prerequisites for the emergence of pathology? What symptoms indicate its presence? And, most importantly, how to treat it? These and many other questions are now worth giving answers.
Causes of pathology
They are few. One, to be precise. The development of a defect begins because of a disorder that occurs at the stage of embryogenesis. That is, at the moment when the fetus only develops in the body of a woman.
The esophagus and trachea are known to arise from the head end of the anterior intestine. This is one germ. In the early stages, these two parts communicate widely. They are separated on the 4-5th week. And if the growth rate does not coincide with the direction and processes of vacuolization (changing the cells of the body), then there will be a risk of development of fetal esophageal atresia.
Also, the cause is often the wrong recanalization process, through which all the formations of the intestinal tube pass.
Unfortunately, medical practice knows many cases when it ended with high water and miscarriage in the first trimester.
It is important to make a reservation that everything is ambiguous. It happens that children with this vice are born to absolutely healthy parents. But stillThere are a number of provoking factors that can contribute to the development of pathology, namely:
- Smoking a pregnant woman.
- Drug use.
- The impact of radiation in the early period.
- Alcohol abuse.
- The impact on the female body of chemicals.
- Use of drugs prohibited during pregnancy.
- Age over 35 years.
These factors can also lead to the development of other pathologies. That is why all bad habits must be abandoned a few months before the planned conception, start taking folic acid, adhere to proper nutrition and a healthy lifestyle.
According to the ICD, the atresia of the esophagus is Q42.The main forms of pathology include such defects:
- Atresia with fistula located between the trachea and the distal esophagus. It occurs in 85-90% of cases.
- Atresia with fistula located between the trachea and the proximal section. It occurs in 0.8% of cases.
- Atresia with fistula, formed between both ends of these organs. It occurs in 0.6% of cases.
- Atresia isolated form. It occurs in 8% of cases.
In rare cases, a tracheoesophageal fistula is formed, but there is no atresia. However, there are even more pathological situations. They are characterized by the complete absence of the esophagus.
Combination with other evils
Considered pathology, according to statistics, occurs in 0.1-0.4% of infants. In most cases, it is combined with the vices of other systems and organs. The most common diseases are:
- Radial dysplasia.
- Deformity of the limbs.
- Pyloric stenosis.
- Tracheoesophageal fistula.
- Atresia Choan.
- Malformation of the spine.
- Agenesis of the gallbladder.
- Abnormalities in the development of the kidneys.
It should also be noted that in 5% of all cases of atresia, chromosomal pathology is diagnosed - Down syndrome, Edwards or Patau.Another 40% of babies are born prematurely.either with intrauterine growth retardation.
Is the diagnosis of pregnancy real?
Yes, for this purpose, prenatal complex diagnostics is carried out. During the ultrasound revealed the following indirect signs:
- Many water. The woman is gaining weight, and the reason for this is the reduced turnover of amniotic fluid. Why does he appear? Due to the fact that the fetus can not swallow amniotic fluid.
- Abnormally small dimensions of the contours of the stomach or even their absence.
The probability of confirmation of a defect according to these signs reaches 50%. If the woman does not terminate the pregnancy, then in the second and third trimesters the doctor will see periods of emptying and filling the blind esophageal end.
If a pathology is suspected, the content of acetylcholinesterase enzyme in the amniotic fluid is determined.
Atresia of the esophagus in newborns makes itself felt during the first hours after the birth of the child. This is manifested in the following symptoms:
- The discharge from the mouth and nose of abundant foamy saliva, which does not stop. This is called false hypersalivation.
- Aspiration of a part of mucus by the infant into the trachea.
- Respiratory disorders: coughing, wheezing, shortness of breath, asphyxia, tachypnea.
- Food regurgitation. The baby cannot swallow the milk - as soon as it gets into his mouth, he spits it up immediately. Vomiting is possible.
- Aspiration pneumonia (due to infant inhalation of food and mucus).
Often the atresia of the esophagus is combined with the lower tracheoesophageal fistula. In this case, the following symptoms are also observed:
- Inhalation of the contents of the stomach.
- Severe paroxysmal cough that occurs with every meal.
- Cyanosis and choking.
- Abdominal distention caused by air entering the stomach and esophagus through a fistula.
- Exhaustion and dehydration.
If there is no fistula, then atresia of the esophagus in the newborn is accompanied by a sunken abdomen.
Ignoring the above symptoms leads to respiratoryfailure, and later to death. Therefore, the diagnosis of esophageal atresia should be carried out promptly - in the first 12-24 hours after the baby is born. Otherwise, the development of aspiration pneumonia will begin later.
If there is even the slightest suspicion of esophageal atresia, the baby is intranasally probed using a rubber catheter. If the child really has this pathology, then the tool simply will not be able to enter into the stomach. The probe will either rest against the blind end of the esophagus, or it will wrap and come back.
If the case is doubtful, the doctors carry out the so-called Elephant test. This procedure consists in the introduction into the esophagus portions of air through a catheter. When atresia, he noisily comes out of the nasopharynx.
Sometimes they can prescribe bronchoscopy and esophagoscopy. Here is what can be done with these procedures:
- Identify the blind end of the esophagus.
- Set the type of pathology.
- Determine the extent of the maximum segment of the blind end of the esophagus.
- Find out if there is a fistulous passage with the bronchi and trachea.
By the way, the last moment can be determined by performing an intraoperative x-controlled esophagoscopy.
Is there a way to establish an absolute diagnosis? Yes, and this is X-ray, during which a radiopaque catheter is inserted into the baby's esophagus.
In rare, especially severe cases, can use a barium suspension. But this is highly undesirable, since there is a high risk of respiratory complications, which are fatal.
It must be performed within 36 hours after birth. Because the worst consequence of atresia of the esophagus in newborns is death.
The operation is carried out under protective blood transfusion, the amount of which usually ranges from 150 to 200 ml. Therefore, a special apparatus is placed on the vein of the lower leg. With his help, and is drip infusion of blood.
The purpose of the intervention is to conduct a direct anastomosis. This is the procedure for stitching two hollow organs, which allows them to be functional. This operation maximizes the baby’s standard of living to a full one.
But the anastomosis is possible only if the diastasis between the segments of the esophagus is not more than 1.5 cm. If more tissue tension is diagnosed, then the operation becomes unjustified, because during the recovery period, the stitches can be stretched and cut.
What happens if the diastasis exceeds 1.5 cm? First, surgeons remove the fistula, after which it becomes possible to bring the upper end of the esophagus to the neck.So it is possible to prevent the development of aspiration pneumonia. Then an infant gut is made from the intestine.
The operation is usually carried out with endotracheal anesthesia with mandatory ventilation of the lungs.
After the operation, the atresia of the esophagus the baby will have a long recovery period. The doctor selects the tactics of treatment, taking into account the following criteria:
- The degree of prematurity.
- Type of combined pathologies.
- The level of respiratory dysfunction.
If the condition of the child is normal, then extubation can be performed - the conclusion of the breathing tube from the trachea. But with the instability of the baby will be connected to the apparatus, through which the forced ventilation of the lungs. And it will be disconnected only when the ability for independent breathing in a child is restored.
It is important to note that in many cases with esophageal atresia in children, the weakness of the tracheal walls is diagnosed. In such a situation, tracheostomy and tracheopexy are indispensable.
Also, after the surgery, the baby’s neck is securely fixed for a period of three to seven days.This is necessary to minimize the risk of seam divergence and tension of the anastomosis applied.
Of course, this period does not end painlessly. That is why babies are administered opioid analgesics through an IV drip, which, once in the body, stops discomfort. On the 3-5th day they usually go for injections. Also, antibacterial therapy is required, which involves the admission of metronidazole by the infant (antiprotozoal agent) in small quantities - 15 mg / kg * day.
Doctors will eliminate the consequences of esophageal atresia over time. After 1.5-2 months, the kids get a rough cough. The cause is scarring and adhesions formed in the trachea and anastomosis areas.
To get rid of this, carry out a special absorbable physiotherapy. But by the age of 5-6 months, babies have another complication. There is an isolated narrowing of the esophagus. Unfortunately, it occurs in 36-50% of cases.
Treatment does not cause difficulties. There are quite a few bougienage sessions that are necessarily carried out under the control of esophagoscopy.
However, it is important to note that conservative procedures do not always help. And because some children spend thoracotomy and plastic of the narrowed section again.
What about nutrition? Feeding fractional, portions increase gradually. On the first day, for example, 10 times in 3 ml is injected through the gastric fistula. In the second - 7 ml. The third - 15 ml. And so on.
A week later, the stomach increases, which allows you to enter already 40-45 ml of fluid, and through the esophagostomy hole. Approximately 1/3 of the nutrition is breast milk and a weak glucose solution.
Unfortunately, if the diagnosis is delayed, the child dies from aspiration pneumonia. If surgical correction is performed promptly, the prognosis will be favorable.
The best chances in infants with atresia are isolated forms. In such cases, the survival rate is about 90-100%. If the child is premature or he has been diagnosed with severely combined defects, then this figure is reduced to 30-50%.
Even in conditions of a successful operation and a satisfactory transesophageal passage, the distal esophagus will not have normal motility. It is simply impossible to restore it completely.
For a whole year, the baby will be in the dispensary, under the constant supervision of a gastroenterologist and surgeon, because after esophageal atresia there is a risk of such complications:
- Dysfunction of swallowing ability.
- Insolvency or obstruction of the anastomosis.
- The development of infection at the junction.
- Narrowing of the passage leading to difficulty swallowing food.
- Muscle weakness.
- Reverse reflux, due to which food is released into the alimentary canal from the stomach.
In case of occurrence of at least one effect of esophageal atresia in children, esophagoscopy is urgently prescribed. It is necessary to inspect the internal surface of the body with special equipment.
What will happen in a few years?
All parents whose children were born with such a pathology are concerned about this issue. Treatment of esophageal atresia is a test for everyone. First for parents, and then for grown-up, already beginning to understand everything children.
In fact, everything is individual here. But if you read what people write, faced with this problem, you can reassure yourself.
It is said that for some time children are really hard for understandable reasons. But over time, they begin to gain weight, and when they are on their feet, most of the symptoms stop, the regurgitation disappears. Some have to do re-plastics.
Also, the child is not recommended to give to the nursery and kindergarten. After all, he needs to follow a strict diet, and in such institutions they can not always offer a separate menu.
If the operation is performed on time, and the rehabilitation period is successful, the child will live a full life.
But in the future he will have to limit himself in the use of junk food, which is an undesirable irritant for the entire digestive system. It's all spicy, smoked, salted, fatty, deep fried, as well as fast food, canned food, etc.
It is better to adhere to a healthy lifestyle and a balanced diet, consuming a sufficient amount of vitamins and macro / micronutrients. And, of course, at least once a year to be examined.