TRACHEOESOPHAGEAL

FISTULA & ESOPHAGEAL

ATRESIA

Dr. Ravi Shankar

Sharma

2nd year resident,

Dept. of Anaesthesia

S.S.M.C. &

S.G.M.H,Rewa

HISTORY

1 day old male

Baby of Uma Kol

Resident of Chandariya, Rewa

Date of Birth- 12/02/2015

Date of Admission- 13/02/2015

Ward-Nicu,GMH

Presenting complaint:Excessive salivation & vomiting(H/o Milk aspiration)

HISTORY OF PRESENT ILLNESS

Parents of patient first noticed excessive salivation with violent coughing leading to vomiting, 6-8 hr after birth of child (immediately after brest feeding)

Onset –acute,Duration-1day

1st feeding was normal, later feeding lead to regurgitation , choking and bluish discolourationof body with excessive frothy salivation

Symptoms aggravated on feeding ,no relieving factor

Not assosiated with any other features

Later pt, breathing became laboured and

child started struggling for breaths

Was not able to feed at all

MATERNAL HISTORY(PAST HISTORY & ANC PERIOD)

G2P2L3A0

UNBooked case/no Ante natal visits/received

1T.T.only

No h/o OCP’s(estrogen/progesterone) for long time

No H/o maternal infectons(VDRL-ve,HbsAg-ve)

NO H/o Gestational D.M./Thyroid abn./PIH

NO H/o Polyhydramnios(normal amniotic fluid

volume)

All previous pregnancies were normal(none of

children had any congenital abnormalities)

MATERNAL HISTORY (DURING LABOUR)

FTNVD with vertex presentation

Twin pregnancy(Attended by Doctor)

No H/o foul smelling dischage/leaking p/v

/uterine tenderness/PPH

Amniotic fluid –clear

Labour –spontaneous & uneventfull

Cry-immediately after birth(no ventillation

was required )

Breast Fed-3 hrs after birth

GENERAL PHYSICAL EXAMINATION

Pt. was alert , conscious, normal cry

Colour-Pink

Tone-Active

No H/o apnoea , Grunting , Chest indrawing

Absence of Jaundice/Bleeding/Bulging anteror

fontanel

Absence of meconium stained cord, skin pustules

Temperature-Afebrile

RR-47/min ,HR-137/min.

Spo2-93%, Weight-3kg

SYSTEMIC EXAMINATION

Respiratory examination:-

• B/l equal air entry

• Chest movements were symmetrical

• No added sounds

Cardiovascular examination:-

s1, s2 normal.

No murmur,

No abnormality detected

Per Abdomen:-

• Soft/Non tender/Non distended

Central nervous examination:-

• Conscious , Motor function – muscle tone, power and DTR within normal limits

• Sensory function within normal limits

AIRWAY EXAMINATION

Chin-Normal sized(No anatomical

abnormality)

Mouth opening-adequate

Previous intubationattepts-Easy

Uvula-visible

No difficulty in Flexion & Extension

INVESTIGATIONS:-

• Hb-20.4 gm%

• TLC-7400 cells/cumm(P-76,L-17,M-4,E-3,B-

0)

• R.B.C-5.3millions/cumm

• MCV-110fl, MCH-39.7pg,MCHC-35.8g/dl

• Platelet-1.9lac.

• C.R.P-Non reactive

• Blood group-o+ve

BIOCHEMICAL TESTS

Description Results

Serum Sodium 137.3 meq/ltr

Serum pottasium 4.5meq/ltr

Blood urea 35mg/dl

Serum Creatinine 0.84mg%

X-RAY:-

SUMMARY:-

A new born male child was admitted to NICU,

with chief complaints of excessive drooling of

saliva & vomiting after brest

feeding.NGT/OGT was tried to introduce in

order to stop further regurgitaion but it failed.

Finally X-Ray(Dye study )was carried out and

Provisional diagnosis of Esophageal atresia

& tracheoesophageal fistula was made by

Paediatric Surgeon