Influence of associated anomalies on the management of oesophageal atresia.

Associated congenital abnormalities occur in over 50% of infants with oesophageal atresia. Many of them influence the way in which the oesophageal atresia is managed and therefore should be detected as soon as possible after birth. Early recognition of those with no prospect of long-term survival (e.g. Trisomy 18, bilateral renal agenesis) will avoid unnecessary surgery to the oesophagus. About 12% of oesophageal atresia infants will have no surgery performed. This paper presents a protocol for the initial investigation and management of associated anomalies in oesophageal atresia, based on an experience of 670 infants treated at the Royal Children's Hospital, Melbourne, Pre-operative detection of associated anomalies of oesophageal atresia requires clinical examination, pre-operative renal ultrasound (if the child has not passed urine), and an echocardiograph of the heart to exclude duct-dependent lesions. If there is clinical suspicion of a major chromosomal abnormality, surgery should be deferred until chromosomal analysis has been completed.

Simple method for confirmation of the presence of H-type tracheoesophageal fistula

Congenital H. type tracheoesophageal fistula presents with clinical features of variable types and severity including shocking, coughing and cynosis with feeds, pneumonia and abdomina distention. the rarity of the condition, its specific symptomatology and limitations in its demonstration by contrast radiology and endoscopy, contribute to delay between the first presentation and confirmation of the diagnosis. In this series of 8 patients, an initial esophagogram demonstrated the fistula in 4 only even after 2 attempts. By using methylene blue injected through an endotracheal tube with an esophagoscope inserted at the same time at the esophageal inlet, confirmed the presence of fistula and its position in all of them. This technique seemed to be simple and safe for confirmation of the presence of H. fistula when the clinical picture is highly suggestive, with negative esophagogram