A newborn with Esophageal atresia and
tracheo-oesophageal fistula:A
male baby was delivered at term by elective caesarian section due to
polyhydraminos. At delivery, the infant was vigorous, birth weight 2.3Kg and
had APGAR score 9 and 10 at one and five minutes. The initial physical
examination at one hour of life was remarkable only for a slight increase in
white oral secretions which were cleared with suction. The baby passed meconium
within the first two hours of life but he refused to take milk orally and
despite of this, his abdomen became distended gradually. At approximately four
hours of life, the infant was noted to have some crackles on routine
auscultation. Respiratory rate was normal. He had drooling of saliva.
Clinically, EA was suspected and an attempt was made to pass an OG tube with
radio-opaque marker. A chest radiograph was obtained (figure:1) which showed OG
tube failed to reach the stomach. Nasogastric aspiration revealed a copious,
mucus like aspirate. A diagnosis of EA with probable TEF was made by seeing
presence of gas in abdomen in x ray. Routine echocardiography showed the
absence of cardiac malformation. No other associated anomalies were noted
except deformed left pinna. Initially, he was prepared for surgery with
parenteral nutrition, propped up position and continuous upper esophageal
suction. The patient underwent surgery on the third day of life. A right
lateral thoracotomy incision was made and chest cavity opened through 4th
intercostal space. By extrapleural approach with single lung ventilation,
posterior mediastinum was exposed and the azygos vein was identified and
divided between the ties. Type ā€œCā€ EA with moderately long long gap (>2 cm) distal
TEF was identified and an ligation of TEF followed by end to end anastomosis of
the esophagus was done which was also checked by giving normal saline into the
posterior mediastinum and no air bubble was seen. Then an intercostal chest
tube drain was left in situ and wound was closed in layers. The postoperative
period was uneventful. He was extubated from ventilator on 2nd post
operative day (POD).

The
baby made excellent recovery and was discharged on 12th POD with
domperidone and H2 blocker medicine for prevention of GERD. Follow
up examination upto the age of 3 years
revealed he was gaining weight normally, having no problem in swallowing,
achieving normal development.

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