TY  - CHAP
M1  - Book, Section
TI  - Congenital Esophageal Anomalies
A1  - Patel, Nishant D.
A1  - Meneshian, Avedis
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyEsophageal  atresia  and  tracheoesophageal  fistula  (EA–TEF)  occurs  in  1  in  3400.  Esophageal  duplication  cysts  represent  10  to  15  percent  of  foregut  duplication  cysts  and  5  to  10  percent  of  mediastinal  cysts.  The  true  incidence  of  esophageal  duplication  cysts  is  unknown.  Congenital  esophageal  stenosis  and  webs  occur  in  1  in  25,000  to  50,000  live  births.ClassificationAnatomic  variations  of  EA–TEF  include  isolated  EA,  EA  with  distal  TEF,  EA  with  proximal  TEF,  EA  with  distal  and  proximal  TEF,  or  N-type  TEF.  EA  with  distal  TEF  is  the  most  common.  Esophageal  duplication  cysts  can  be  cervical,  thoracic,  or  abdominal.  Esophageal  stenosis  and  webs  can  be  characterized  on  the  basis  of  etiology  into  fibromuscular  thickening,  trachobronchial  remnants,  and  membranous  web.Clinical  featuresEA–TEF  is  suggested  by  polyhydramnios,  and  infants  present  with  drooling,  rhonchi,  aspiration  with  subsequent  respiratory  distress.  Esophageal  duplication  cysts  are  often  asymptomatic.  Symptoms  due  to  esophageal  duplication  cysts  are  secondary  to  mass  effect  and  include  dysphagia  and  respiratory  insufficiency.  Congenital  esophageal  stenosis  and  webs  present  in  infancy  with  dysphagia  and  vomiting  of  solid  food.DiagnosisEA–TEF  is  readily  diagnosed  with  passage  of  a  10-F  esophageal  tube  and  gentle  insufflation,  and  plain  chest  radiograph.  The  presence  of  air  in  the  stomach  confirms  a  distal  TEF,  and  its  absence  suggests  isolated  EA.  Esophageal  duplication  cysts  are  also  diagnosed  on  plain  film  and  confirmed  with  esophagography  and  CT.  Esophageal  stenosis  and  web  are  diagnosed  with  esophagography  and  endoscopy.TreatmentSurgical  repair  of  EA–TEF  consists  of  a  single-layer  primary  anastomosis  of  the  proximal  and  distal  esophageal  segments  and  ligation  of  any  TEF.  Esophageal  duplication  cysts  are  resected.  Esophageal  stenosis  and  webs  are  initially  managed  conservatively  with  dilatation.  Surgical  treatment  is  reserved  for  stenosis  refractory  to  dilatation  and  consists  of  resection  of  the  stenotic  segment  and  primary  anastomosis.ComplicationsOutcomes  following  repair  of  EA–TEF  are  good.  Early  complications  include  anastomotic  leak  and  subsequent  sepsis.  Mid-to-late-term  complications  include  stricture,  recurrent  fistula,  and  gastroesophageal  reflux.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104586107
ER  -