eMedicine Specialties > Pediatrics: Surgery > General Surgery
Congenital Anomalies of the Esophagus: Multimedia
Updated: Oct 31, 2008
Multimedia
 | Media file 1: Fetal MRI showing normal esophagus. This study is negative for esophageal atresia. The hypopharynx and proximal esophagus are normal caliber (arrows), and a normal thoracic esophagus (E) is observed. |
 | Media file 2: Fetal MRI that reveals esophageal atresia. The proximal esophagus and hypopharynx are dilated (arrow). The thoracic esophagus is not discernible. |
 | Media file 3: Plain radiograph in a newborn suspected of having esophageal atresia. Air in the stomach and intestine suggest a distal tracheoesophageal fistula. |
 | Media file 4: Pure esophageal atresia. Newborn with tube in proximal pouch. Note that no air is in the stomach or intestine (a gasless abdomen). |
 | Media file 5: Animation illustrating method to estimate distance for esophageal atresia (EA) with distal tracheoesophageal fistula (TEF). A small amount of air has been injected into the upper pouch. The upper pouch and bifurcation of the trachea are marked. The distal fistula is usually posterior to the carina. |
 | Media file 6: Contrast study of the upper pouch in an infant with esophageal atresia and distal tracheoesophageal fistula. |
 | Media file 7: Tracheobronchial remnant in distal esophagus of an infant with pure esophageal atresia. |
 | Media file 8: Gapogram estimating distance between the proximal pouch (P) and the distal pouch (D). The proximal pouch has mercury-weighted dilator, and the distal pouch is filled with contrast injected through a gastrostomy (G). The distance is more than 5 cm and 5 vertebral bodies. |
 | Media file 9: Gapogram demonstrating 3.4-cm gap. The distal pouch is being stretched with radiopaque dilator. |
 | Media file 10: Gapogram demonstrating pure esophageal atresia before surgical repair. Green lines show gap distance less than 2 cm between mercury-weighted dilator in upper pouch and contrast in distal pouch. |
 | Media file 11: Intraoperative photograph illustrating azygous vein. A right thoracotomy and retropleural dissection has been performed. |
 | Media file 12: Intraoperative photograph during repair of esophageal atresia. The head is to the left. The azygous vein has been divided. The proximal (P) and distal (D) esophageal pouches can be easily observed. |
 | Media file 13: Intraoperative photograph showing primary anastomosis (A) between the proximal and distal esophagus. |
 | Media file 14: Contrast study demonstrating colonic interposition. The colon is sutured to the cervical esophagus proximally and the stomach distally. No leak or stricture is noted. |
 | Media file 15: Contrast swallow (oblique view) demonstrating a gastric pull-up used as esophageal replacement in a child with pure esophageal atresia. Note stomach in chest. |
 | Media file 16: Intraoperative photograph demonstrating proximal H-type fistula (F) between the proximal esophagus (P) and trachea (T). The blue vessel loop is around the fistula. The H-type fistula was not diagnosed preoperatively; it was identified while mobilizing the proximal esophagus in a child with congenital esophageal stenosis. |
 | Media file 17: Intraoperative photograph following division and repair of H-type fistula. Note sutures in the esophagus (E) and trachea (T). |
 | Media file 18: Intraoperative photograph of an infant thought to have esophageal atresia. The proximal (P) and distal esophagus was connected by a fibrotic segment of congenital esophageal stenosis (CES) beginning at the azygous vein (A). No distal tracheoesophageal fistula was present. |
 | Media file 19: Intraoperative photograph following resection of an atretic segment of esophagus and primary anastomosis (A) of the proximal (P) and distal esophagus. The azygous vein (AV) was preserved. |
 | Media file 20: Chest radiograph immediately following repair of esophageal atresia and distal tracheoesophageal fistula (TEF). Note the chest tube (CT) in the retropleural space and the feeding tube passing through the anastomosis (A) into the stomach. |
 | Media file 21: Chest radiograph following repair of esophageal atresia. The chest tube is placed in the retropleural space (CT). No feeding tube is passing across the anastomosis. |
 | Media file 22: Esophagogram one week following primary anastomosis for pure esophageal atresia. No leak or stricture is observed. |
 | Media file 23: Anastomosis disruption following repair of esophageal atresia with a tracheoesophageal fistula. Contrast was injected through a gastrostomy and refluxed through the distal esophagus. The leak (L) is draining into the retropleural chest tube. |
 | Media file 24: Esophagogram 1 week after repair of esophageal atresia with a distal tracheoesophageal fistula (TEF). Note narrowing at anastomosis (A). The child was asymptomatic and required no dilatations. Image 1 of 3 in series. See Media files 25-26. |
 | Media file 25: Follow-up esophagram demonstrating spontaneous improvement of narrowing at the anastomosis (A). Image 2 of 3 in series. See Media files 24 and 26. |
 | Media file 26: Esophagogram in the patient from Media files 24-25 2 months later. Note spontaneous resolution of narrowing at the anastomosis (A). No intervention was required in this child. Image 3 of 3 in series. See Media files 24-25. |
 | Media file 27: Esophagogram 7 days following repair of esophageal atresia. Note the change in caliber from the proximal esophagus to the distal esophagus at the anastomosis (A). The retropleural chest tube can be observed (CT). This patient had gastroesophageal reflux and developed a progressive stricture. Image 1 of 3 in series. See Media files 28-29. |
 | Media file 28: Esophagogram of the same patient in Media file 27 obtained 3 weeks later demonstrating stricture (A) and gastroesophageal reflux (R and green arrow). Medical therapy was initiated. See Media files 27 and 29. |
 | Media file 29: Esophagogram of the same patient in Media files 27-28 performed 2 weeks later demonstrating worsened anastomotic stricture (A). The patient responded well to Bouginage dilatation and medical management of the reflux. See Media files 27-28. |
 | Media file 30: Esophagogram demonstrating impacted food in a 5-year-old child with a history of esophageal atresia repair. |
 | Media file 31: Esophageal atresia with a tracheoesophageal fistula. |
More on Congenital Anomalies of the Esophagus |
| Overview: Congenital Anomalies of the Esophagus |
| Workup: Congenital Anomalies of the Esophagus |
| Treatment: Congenital Anomalies of the Esophagus |
| Follow-up: Congenital Anomalies of the Esophagus |
 Multimedia: Congenital Anomalies of the Esophagus |
| References |
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Further Reading
Keywords
congenital anomalies of the esophagus, esophageal atresia, EA, tracheoesophageal fistula, TEF, esophageal stenosis, esophageal cyst, tracheobronchial remnant, esophageal atresia and tracheoesophageal fistula, EA-TEF, esophageal web, esophageal muscular hypertrophy, esophageal duplications, esophageal rests, columnar epithelium–lined lower esophagus, Barrett esophagus, Barrett's esophagus, laryngotracheoesophageal cleft, LTEC, gastroesophageal reflux, GERD, oculodigitoesophageoduodenal, ODED, Feingold syndrome, trisomy 18, Down syndrome, pneumonia, atelectasis, polyhydramnios, pneumonitis, tetralogy of Fallot, imperforate anus
