Abstract
Four pre-term neonates with tracheo-oesophageal fistula required positive pressure ventilation because of the respiratory distress syndrome. Gastric rupture occurred in two patients, one of whom died. Ineffective ventilation was critically impaired by formation of a gastrostomy in a third patient, who also died. Direct ligation of the fistula in the fourth critically ill patient led to a dramatic improvement in gas exchange. When the resistance of the airways exceeds that of the fistula, gas escapes through the latter into the gastro-intestinal tract. Formation of a gastrostomy lowers intragastric pressure and thus the resistance to gas escape via the fistula; respiratory support is thus rendered ineffective. Effective ventilation is only possible after occlusion of the fistula, which we believe is best achieved by direct ligation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Calverley RK, Johnston AE (1972) The anaesthetic management of tracheo-oesophageal fistula: a review of ten years' experience. Can Anae Soc J 19: 1st 270–282
Filston HC, Chitwood WR Jr, Schkolne B, Blackmon LR (1982) The Fogarty balloon catheter as an aid to management of the infant with oesophageal atresia and tracheo-oesophageal fistula complicated by severe RDS or pneumonia. J Pediatr Surg 17: 149–151
Gamble HA (1938) Tracheo-oesophageal fistyla — description of a new operative procedure. Ann Surg 107: 701–707
Grosfeld JL, Ballantine TVN (1978) Esophageal atresia and tracheo-oesophageal fistula: effect of delayed thoracotomy on survival. Surgery 84: 394–402
Haight C, Towsley HA (1943) Congenital atresia of the oesophagus with tracheo-oesophageal fistula: extrapleural ligation of fistula and end-to-end anastomosis of oesophageal segments. Surg Gynecol Obstet 76: 672–688
Holder TM (1986) Esophageal atresia and tracheo-oesophageal fistula. In: Ashcraft KW, Holder TM (eds) Pediatric esophageal surgery. Grune and Stratton. Orlando, USA pp 29–52
Jones JB, Kirchner SG, Lee FA, Heller RM (1980) Stomach rupture associated with esophageal atresia, tracheo-oesophageal fistula and ventilatory assistance. AJR 134: 675–677
Koop CE, Schnaufer L, Broeule AM (1974) Esophageal atresia and tracheo-oephageal fistula: supportive measures that affect survival. Pediatrics 54: 558–564
Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18: 217–229
Martin LW, Alexander F (1985) Esophageal atresia Surg Clin Am 65: 1099–1113
Randolph JG, Tunell WP, Lilly JR (1968) Gastric division in the critically ill infant with oesophageal atresia and tracheo-oesophageal fistula. Surgery 63: 496–502
Salem MR, Wong AY, Lin YH (1973) Prevention of gastric distension during anesthesia for newborns with tracheo-oesophageal fistulas. Anesthesiology 38: 82–83
Templeton JM Jr, Templeton JJ, Schnauffer L, Bishop HC, Ziegler MM, O'Neill JA Jr (1985) Management of esophageal atresia and tracheo-oesophageal fistula in the neonate with severe respiratory distress syndrome. J Pediatr Surg 20: 394–397
Waterson BJ, Bonham-Carter RE, Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula: a study of survival in 218 infants. Lancet 1: 819–822
Author information
Authors and Affiliations
Additional information
Offprint requests to: E. M. Kiely
Rights and permissions
About this article
Cite this article
Holmes, S.J.K., Kiely, E.M. & Spitz, L. Tracheo-oesophageal fistula and the respiratory distress syndrome. Pediatr Surg Int 2, 16–18 (1987). https://doi.org/10.1007/BF00173599
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00173599