Tracheooesophageal fistula

This is what i asked the doctor just now
IN ONE OF THE BABIES WITH TRACHEO OESOPHAGEAL FISTULA, THE FIRST PRESENTATION RIGHT AFTER BIRTH WAS… RESPIRATORY DISTRESS…. WHY????

Normally…. In Tof, dpending on which type…. If there is oesophageal atresia…. So there maybe accumulation of saliva…which will enter the respiratory tract by the larynx i suppose… Leading to aspiration….or…if we do feeding to the baby,…( not in the same case though) the milk may get aspirated to…or…. After feeding,… Depending on the type of tof…gastric reflux may enter the respiratory tract by the fistula..
The doctor drew this

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Btw…if the upper oes pouch is too much away from the lower pouch… Gastrotomy and oesophagotomy is done…and temporary?

Some xrays on TOF

search for the kinked nasogastric tube.
The stomach may or may not be distended…this dpends on the type of TOF.if the fistula is connected to the oesophagus then to the stomach..so some air will enter causing this distension.

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How to manage?
Prior to operation…give him medical care…. The primary repair….should be delayed if his lungs condition doesnt permit him ….
Medical care includes:
Continuous suctioning to prevent aspiration
ETI distal to the part of fistula to prevent GASTRIc REFLUX
Be aware that this condition may deteriorate the lung due to the aspiration…if he has infection…administer antibiotics….

Extracted from emedicine…read further here.

If the patient develops acute respiratory failure, endotracheal intubation and mechanical ventilation are performed. Administer broad-spectrum antibiotics for patients who may have developed lower respiratory tract infection. For patients known to have pneumonia or other pulmonary problems, a gastrostomy for gastric decompression may be required to prevent further reflux of gastric contents into the trachea. The use of proton pump inhibitors may be helpful.

Btw….this is the most common type

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