Congenital obstruction (atresia) of the esophagus – causes, symptoms, diagnosis, treatment

Congenital oesophageal obstruction should be suspected if the newborn refuses to suckle, develops drooling, coughing and cyanosis attacks. In addition, attempts to feed even a small amount of food cause choking and regurgitation of unchanged food. In children with suspected esophagus, food should not be given.

Congenital obstruction (atresia) of the esophagus

Congenital oesophageal obstruction is a defect whose causes are not entirely clear. Esophageal atresia is sometimes also referred to as esophageal atresia. The essence of the disease is the unformed part of the esophagus, which prevents it from maintaining its continuity (one or both ends of the esophagus have a dead end). In half of patients, esophageal atresia resolves spontaneously, while in others – it coexists with other defects, e.g. anal atresia, heart and kidney defects. Esophageal atresia is common in patients with Down’s disease. It is considered the most severe form of this ailment long segment obstruction of the esophaguswhere the primary fusion of both esophagus sections is impossible. Long-segment oesophageal obstruction should be considered when the oesophageal obstruction is not associated with an oesophagotracheal fistula. In milder forms of the disease, the esophagus is characterized only by stenosis, but is accompanied by an esophageal-tracheal fistula in the form of the letter “N” or “H”.

Causes of congenital obstruction of the esophagus

To date, the specific causes of esophageal obstruction have not been clarified. Nevertheless, genetic factors are taken into account, it is likely that this defect is formed before the 32nd day of pregnancy. Esophageal atresia is known to occur alone, but may sometimes be associated with other birth defects. Then genetic syndromes are formed. The disease incidence is 1 in 3500 live births. The highest incidence rate is observed in Finland. Congenital obstruction of the esophagus is more common in twins.

Interesting fact: the risk of conceiving a child with congenital obstruction of the esophagus by a parent who was burdened with this defect himself was estimated at 3 to 4%.

Congenital atresia of the esophagus – symptoms

In children with congenital oesophageal obstruction, the first characteristic defect is that the child does not swallow amniotic fluid. After birth, the toddler develops symptoms such as breathlessness and cyanosis. Over time, hiccups, coughing, and rapid breathing join in. Excessive drooling and the inability to swallow saliva on your own means that the excess comes out through the nose. Only the loosening of the nose helps to get rid of this unpleasant symptom.

The most important: in children with suspected oesophageal atresia, food should not be given until the defect has been ruled out! Before the correct diagnosis is made, the child is fitted with a saliva suction and breathing probe.

How do we diagnose congenital esophageal obstruction?

The diagnosis can be made at the stage of prenatal examinations. From around the 18th week of pregnancy, an ultrasound examination reveals any abnormalities related to the development of the fetus. In order to unequivocally confirm the diagnosis and thus exclude other defects – chromosome tests are performed.

The presence of esophageal obstruction may also be indicated by polyhydramnios, visible in the third trimester of pregnancy. After the baby is born, an X-ray of the chest and abdomen is made to confirm the initial diagnosis, after contrast administration.

Treatment of congenital obstruction of the esophagus

The treatment of choice is surgery that restores the continuity of the esophagus and widens its lumen. In cases where there is an additional fistula with the trachea, it should be removed during the operation. During the procedure, the doctor joins the blindly ended sections of the esophagus and sutures them together. Sometimes it is necessary to create the missing section of the esophagus, then a large or small intestine fragment is transplanted.

Surgery, like any operation, is associated with the possibility of complications. Immediately after the surgery, leakage of the formed anastomosis may appear, which usually occurs in the bloody day after the surgery. This situation is dangerous because the anastomosis formed may be broken or constricted. In addition, infection and sepsis may occur. Other complications that appear a little later are:

1. gastroesophageal reflux,
2. softening of the trachea,
3. esophageal motility disorders.

Congenital oesophageal obstruction and breastfeeding

Women of children with suspected oesophageal atresia should wean the baby. In such situations, in order for the lactation level to be maintained – it is recommended to express milk using a special breast pump. After surgery, the baby is fed with a gastrostomy, then it is possible to give the mother’s milk directly to the baby’s tummy. Breastfeeding can only be resumed after treatment has been completed and after making sure that no postoperative complications have occurred.