How does a patient with a TEF typically present?
In utero, there is often polyhydramnios, as the
fetus can-not swallow amniotic fluid secondary to the esophageal atresia. At
the time of delivery, an orogastric tube cannot be passed into the stomach.
Typically, the orogastric tube will only pass to a distance of approximately 10
cm from the gums. In most cases, the diagnosis is initially suspected at the
first feeding, when the neonate presents with coughing, choking and cyanosis
(the “three Cs”). Excessive salivation and respiratory distress can also occur.
Confirmation of the diagnosis is made
radiographically when a radiopaque orogastric catheter is seen curled in the
proximal esophageal pouch. The presence of air in the stomach and intestines on
radiography signifies the pres-ence of a fistula between the trachea and distal
esophagus.
The “H” type fistula (tracheoesophageal fistula
without atresia) usually presents later in life, most commonly with choking
during feedings and recurrent pneumonitis.
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