Congenital malformations or hereditary pathologies appear at different periods of life. Some diseases can be detected in adulthood, while others appear immediately after the birth of a child. Among these pathologies is atresia of the esophagus. Esophageal atresia – This is a congenital underdevelopment of the esophagus, in which the opening in the esophagus is completely absent and has the form of proximal and distal segments separated from each other. Esophageal atresia is a severe malformation that is life threatening without early surgical treatment. What are the causes and manifestations of esophageal atresia?
The main causes of esophageal atresia in children
Esophageal atresia develops when the formation of the esophagus is disturbed in embryogenesis - from 4 to 12 weeks from conception. The esophagus develops from the cranial part of the primary intestine along with the trachea, then they communicate with each other. If there is a violation of the process of their separation - esophageal atresia is formed. Violations can be with a change in the speed and direction of growth of the esophagus and trachea, with incomplete separation of the respiratory tube from the esophagus, as well as with a violation of its nutrition.
Disturbances in the process of recanalization of the intestinal tube are often the cause of esophageal atresia. There are several types of esophageal atresia. The most common is atresia with a fistula between the distal esophagus and the trachea, accounting for up to 90% of cases. In the complete absence of the esophagus, we are talking about aplasia of the esophagus.
What are the symptoms of esophageal atresia?
Esophageal atresia manifests itself already in the first hours of a child's life.
The main characteristic sign of esophageal atresia is false hypersalivation, which is manifested by copious secretion of foamy saliva from the mouth and nose.
Some of the mucus enters the trachea, which contributes to respiratory failure. Wheezing, cough, tachypnea, cyanosis, shortness of breath are observed. Suction of mucus from the nasopharynx improves the condition for a while, after which the symptoms recur. The first feeding is accompanied by regurgitation and regurgitation of uncured milk.
Clinical manifestations of esophageal atresia:
- If esophageal atresia is combined with a tracheoesophageal fistula, this is manifested by the reflux of stomach contents into the respiratory tract. At each feeding, the child begins to choke and has a severe paroxysmal cough, which is accompanied by choking and cyanosis.
- Some children have bloating in the epigastric region against the background of air entering the esophagus and stomach through the esophagus.
- If there is no distal fistula, then the child with atresia has a sunken tummy.
Diagnosis and treatment of esophageal atresia. What is the danger of esophageal atresia?
Esophageal atresia requires urgent diagnosis at the first suspicion of it.
For this, intranasal probing of the esophagus is performed. The probe rests on the blind end with atresia of the esophagus. The Elephanta test is carried out in doubtful cases. Esophagoscopy and bronchoscopy makes it possible to establish the type of atresia. X-ray with the introduction of a radiopaque substance into the esophagus allows you to finally confirm the diagnosis.
Before treatment, it is important to make a differential diagnosis of esophageal atresia with the following pathologies:
- esophageal stenosis;
- esophagospasm;
- congenital pyloric stenosis;
- cleft larynx, tracheoesophageal fistula.
In the process of diagnosis, it is necessary to distinguish the fistulous form of esophageal atresia from the non-fistulous form.
The danger of esophageal atresia is rapid dehydration against the background of vomiting. Inhalation of mucus leads to the development of aspiration pneumonia, which is accompanied by respiratory failure and fever. Without timely treatment, esophageal atresia is fatal.
Treatment of esophageal atresia is surgical and should be done within the first 36 hours of a child's life.
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