WELCOME

CASE PRESENTATION ON
TRACHEAOESOPHAGEAL
FISTULA
PRESENTED BY NIHARIKA
PBBSC N 1ST YEAR
INTRODUCTION
 A Tracheoesophageal fistula is a
congenital disease. It is a acquired
communication between the trachea
and esophagus. Most of the patient
with TEF are diagnosed immediately
following after birth.TEF are often
associated with life threatening
complications.
DEFINITION
 A Trachoesophageal fistula is an
abnormal connection between the
esophagus and the trachea. A fistula
from the Latin meaning a pipe is an
abnormal connection running either
between two tubes or between and a
tube and surface.
INCIDENCE
Approximate 17-70% of children with
TEFs have associated development
anomalies . These anomalies include
Down syndrome, duodenal Artesia
and cardiovascular defect.
 TEFs are a common congenital
anomaly with an incidence of 1 case in
2000-4000 live births.
ETIOLOGY
 Maternal alcohol and smoking
 Exogenous sex hormones
 Exposure to methimazole
 Prolonged mechanical ventilation via
Endotracheal or tracheotomy tube
 Maternal polyhydamnious
 In first trimester exposure to Diabetes
mellitus
PATHOPHYSIOLOGY
 Upper part of esophagus is developed from retropharyngeal
segment and the lower part of the first part of primitive gut.

 At 4-5 weeks of gestation the laryngeal-tracheal groove is formed.

 Two longitudinal furrows develop and separate the respiratory

tract permordium from esophagus.

 Deviation cellular growth of the septum results in formation of

fistula between esophagus and trachea.
SIGN AND SYMPTOMS
 Excessive secretion
 Intermittent, unexplained cyanosis and
laryngospasm
 Abdominal distention
 Violent response after first or second
swallow of feeding such as infant cough
and chokes fluid returns through nose
and mouth
 Poor feeding
 Inability to pass catheter
Diagnostic Evaluation
 Ultrasound scanning
 Failure to pass 10F into the stomach
through nose or mouth
 Catheter left in situ while an x- ray
diagnosis
 PH of tracheal secretions in acidic
 Flat plate x-ray of abdomen and chest
 Barium x-ray
 Electrocardiogram
PHARMOLOGIC MANAGEMENT
 Propping infant at 30 degree angle
 Nasogastric tube remains in the
esophagus and it is aspirated
frequently
 Nothing by mouth
 Supportive therapy include meeting
nutritional requirements IV fluid,
antibiotics , respiratory support and
maintaining neutral environment
 SURGICAL MANAGEMENT
 Prompt primary repair: fistula found by
bronchoscopy is divided, followed by
esophageal anastomosis of proximal and
distal segments if infant weight permit and is
with out pneumonia.
 Staging: Initially fistula division gastrostomy
are performed with later secondary
esophageal anastomosis or colonic
transposition performed approximately 1
year later to effect total repair
CONTI
 Circular esophagotomy: It may be
performed on proximal pouch to gain
length and allow foe primary
anastomosis at initial surgery.
 Cervical esophagotomy : When ends
of esophagus are too widely
separated ,esophagus replacement
with segment of intestine (colonic
transposition ) is done at ages 18 to
24 months.
Continue
 Fiberoptic Tracheoscopy: Repair of
trachesophageal fistula can expedite
and facilitate surgery on ventilated
patient.
 COMPLICATIONS;
 Esophagitis
 Esophageal strictures
 Recurrent fistula
 Death from asphyxia
 Pneumonitis
 Dehydration
NURSING DIGNOSIS
 Risk for aspiration related to structural
abnormalities as evidence by neonate
is not able to swallow.
 Fluid volume deficit related to inability
to take oral fluids as evidence by nil
per oral status.
 Ineffective airway clearance related to
surgical intervention.
 Fear and anxiety of the parents
related to critical situation of neonate
as evidence by parents look anxious.
 CONTINUE
 Acute pain related to surgical procedure
as evidence by child is continuously
crying.
 Ineffective infant feeding pattern related
to congenital defect.
 Impaired tissue integrity related to post
operative defect.
 Knowledge defect related to home base
care as evidence by parents asking so
many question regarding disease
THANK YOU