Case: Tracheo-esophageal fistula

Baby of RK was born via a Caesarian section for unstable lie at term on the 17th January 2013. AFI was 18. Otherwise no prior anomaly scan was done. She had no other antenatal risk factors. The baby was born vigorous. However at 5 minutes of life noted excessive drooling and the nurse complained of inability to insert the ryles tube deeply during suctioning. The baby had no other physical deformities otherwise.

The child was referred to pediatrics for further evaluation. Chest x-ray revealed the following

Coiling of the ryles tube was noted at the level of the upper chest wall. Stomach air was seen. Vertebrae was normal.

The child was referred to pediatric surgery and an impression of esophageal atresia was made. Surgery was scheduled the next day.

Incision was made below the scapula on the right posterior chest wall up to the anterior axillary line. The chest was opened in layers, the esophagus and trachea exposed via extrapulmonary approach.

Findings of proximal esophageal atresia with distal trache-esophageal fistula was noted. The gap of the defect was about 2 cm. Ligature of the fistula was done followed by primary anastamosis of the esophageal ends with the help of a size 8 Fr ryles tube. Leak test was done after closure. Right chest tube was inserted post-operatively.

Patient was cared in the NICU during which he had complications of left lung atelactasis and worsening of right sided pneumothorax. A new chest tube was inserted reducing the extent of the pneumothorax.

Pneumothorax post-op

Patient also suffered from new onset of sepsis which was treated with antibiotics.

Mechanical ventilation was weaned off, and ryles tube feeding started at day 13 post-op. Breastfeeding initiated at day 24 post-op.

***Discussion to be made later.