Congenital Atresia of the Esophagus and Tracheo-Esophageal Fistula

Abstract

The relatively meager roentgenologic literature on the subject of congenital esophageal atresia has dealt almost exclusively with isolated case reports. The apparent reason why more comprehensive analyses of the subject have not appeared is that, until very recently, this interesting anomaly has been universally fatal and generally regarded as a distinct medical oddity. The condition is relatively uncommon, but through various improvements in surgical technic and postoperative care it has been brought into the realm of surgically correctable abnormalities, and greater interest is being taken in the establishment of its diagnosis. Many of the diagnostic and therapeutic problems which have arisen confront the roentgenologist directly, because it is largely by his methods that the diagnosis of esophageal atresia, the recognition of its complications, and the results of surgical management are graphically recorded. It may be stated justifiably that roentgen examination is essential in the proper management of the condition, especially during the postoperative period. The purpose of this report is to review the previously described roentgenologic findings in esophageal atresia and tracheo-esophageal fistula, and to present some additional observations made in the group of 46 patients with various combinations of these anomalies seen at the University Hospital since July 1935. Literature For excellent embryologic descriptions of the anomalies under discussion, the reader is referred to the articles of Singleton and Knight (1) and of Chont and Starry (2). The anatomic relationships of the usual type of combined esophageal atresia and tracheo-esophageal fistula are shown particularly well in postmortem roentgenograms which illustrate a case reported by Sussman (3). Brennemann's description (4) of the clinical findings in these patients is classical. Comprehensive summaries of the cases reported in the medical literature have been contributed by Plass (5), Rosenthal (6), Strong and Cummins (7), and Ashley (8). Methods of surgical management are contained in the communications of Leven (9, 10), Lanman (11), Ladd (12), Haight and Towsley (13), and others (14–20). Classification of Lesions Vogt's widely quoted classification of esophageal anomalies (21) has withstood the test of time because it is simple and usable. He lists the following types: Type I. Complete absence of the esophagus Type II. Atresia of the esophagus with an upper and lower esophageal segment, each ending in a blind pouch. Type III. Atresia of the esophagus with tracheo-esophageal fistula. With fistula between upper segment and trachea. With fistula between lower segment and trachea. With fistula between both segments and the trachea. To this group might be added that form of single tracheo-esophageal fistula which exists without esophageal atresia. This type is unusual and presents particular diagnostic difficulties.