Cases reported "Tracheoesophageal Fistula"

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1/18. [Operated esophageal atresia of late diagnosis, with postoperative survival]

    The authors present two cases of oesophageal atresia with oeso-tracheal communication that, although they have been diagnosed in the 2-nd and the 4-th day of life, have been operated successfully. Both children, investigated at the age of one and one and a half years respectively, are in perfect health.
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2/18. Communicating bronchopulmonary foregut malformations: classification and embryogenesis.

    Communicating bronchopulmonary foregut malformations (CBPFMs) are characterized by a fistula between an isolated portion of respiratory tissue (ie, a lung, a lung lobe, or a segment) and esophagus or stomach. We combine our 30-year (1959 to 1989) experience of 6 cases with 51 reported patients to propose a CBPFM classification supported by a proposed embryogenesis theory. Group I (16%): anomaly is associated with esophageal atresia and tracheoesophageal fistula. Group II (33%): one lung originates from the lower esophagus. Group III (46%): an isolated anatomic lung lobe or segment communicates with the esophagus or stomach. Group IV (5%): A portion of the normal bronchial system communicates with the esophagus. The portion of the lung served by the communicating bronchus receives systemic blood supply. The right and left lung sacs curve dorsally to embrace the lower esophagus during normal lung development. At this stage a part of the lung bud joins the esophagus. This segment then breaks away from the main pulmonary anlage to form a CBPFM. CBPFMs should be considered in the workup of infants with respiratory distress and/or recurrent pneumonias. patients with suspected pulmonary sequestration should undergo contrast studies to exclude a gastrointestinal communication.
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3/18. Successful thoracoscopic repair of esophageal atresia with tracheoesophageal fistula in a newborn with single ventricle physiology.

    A neonate with VACTERL association including tricuspid atresia was scheduled for thoracoscopic esophageal atresia with tracheoesophageal fistula (EA/TEF) repair and laparoscopic gastrostomy tube placement. In addition to standard noninvasive monitoring, arterial blood pressure, central venous pressure, and cerebral oxygen saturation were monitored. Gastric distension resulting from positive pressure ventilation prevented laparoscopic gastrostomy tube placement. thoracoscopy with a CO2 insufflation pressure of 6 mm Hg at low flow (1 L/min) was well tolerated hemodynamically despite hypercarbia and cerebral oxygen saturation was maintained. Careful monitoring and good communication were critical to the safe management of this single ventricle patient during thoracoscopic EA/TEF repair. IMPLICATIONS: Esophageal and tracheoesophageal fistula in conjunction with single ventricle physiology carries a significant risk of mortality. We present the anesthetic management of a neonate with unpalliated tricuspid atresia who underwent thoracoscopic tracheoesophageal fistula repair.
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4/18. Sirenomelia (Mermaid baby).

    Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.
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5/18. Massive gastric distention in the intubated patient. A marker for a defective airway.

    Tracheal intubation is a commonly performed procedure generally associated with a low complication rate. A clinical sign that could lead to early detection of complications could improve management of mechanically ventilated patients. We present two instances of potentially lethal complications that were heralded by the presence of massive gastric distention. This finding should alert physicians that an abnormal communication may exist between the endotracheal tube and the gastrointestinal tract.
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6/18. Congenital tracheoesophageal fistula (H-type) in a six-year-old.

    The case of a six-year-old boy with newly diagnosed tracheoesophageal fistula of the H-type is presented. This diagnosis is usually made in the neonatal period, but since the symptoms may mimic other respiratory illnesses and radiologic diagnosis may be difficult, the condition may go undiagnosed for years. Since correction of a tracheoesophageal fistula is curative, the diagnosis should be entertained in any child with recurrent respiratory symptoms, especially when associated with meals. A brief discussion emphasizes the importance of good communication between the clinician and radiologist and of careful radiologic evaluation.
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7/18. Unrecognized tracheo-oesophageal fistula.

    A patient with a retropharyngeal carcinoma was anaesthetized for laryngoscopy, oesophagoscopy and biopsy. Suggestive symptoms of a tracheo-oesophageal fistula were absent and a barium swallow did not demonstrate its presence. Sign of an abnormal communication appeared for the first time after the patient had been intubated and positive airway pressure applied. Measures which might be taken to overcome this problem are suggested.
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8/18. twins discordant for vater association. Obstructed labor of the second twin due to ascites and persistent cloaca without communication to the exterior.

    The unusual delivery of a dead second twin with rare malformations is presented. The first twin, born live following a normal labor, had no malformations. The birth of the second twin was obstructed by massive ascites, and its abdomen had to be perforated before delivery. The sex could not be determined due to lack of the internal genitalia and the fetal appearance of the external genitals. The left kidney and ureter were hypoplastic. The right ureter and distal part of the colon were dilated and opened into a large primitive cystic cloaca without communication to the exterior. The ascites was probably caused by the urinary obstruction. These malformations probably represent one of the earliest arrested developments of the embryonic hindgut. The presence of a tracheo-esophageal fistula and a single umbilical artery, together with the anal atresia and the renal anomalies, could indicate that the anomalies formed part of the VATER association.
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9/18. Tracheo-oesophageal anomalies in the Goldenhar anomalad.

    A case of the Goldenhar anomalad is presented with a previously undescribed association with oesophageal atresia and tracheo-oesophageal fistula. This is the second instance of a tracheobronchial-oesophageal communication being found in association with the anomalad. awareness of this combination may facilitate future diagnosis and treatment of the anomaly.
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10/18. Acquired tracheoesophageal fistula.

    This is a case of an acquired tracheoesophageal fistula induced by a large foreign body in a 5-yr-old child. The foreign body, a large plastic ear from a doll, was lodged in the esophagus and its presence remained unknown for weeks, until tracheoesophageal fistula actually developed. The foreign body was removed endoscopically; after the child was given intravenous nutrition and the infection was brought under control, the communication was divided and repaired.
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