METRO COLLEGE OF NURSING, GREATER NOIDA

TOPIC- TRACHEOESOPHAGEAL FISTULA

PRESENTED BY: -
AMARA
M.SC. NURSING FIRST YEAR
DEPARTMENT- CHILD HEALTH NURSING
INTRODUCTION

Tracheoesophageal fistula (TEF) and oesophageal atresia are the

congenital malformation of digestive system, in which oesophagus
does not develop properly.

The oesophagus is a tube that normally carries food from the mouth
to stomach.
DEFINITION

Oesophageal atresia: -

Oesophageal atresia is the failure of oesophagus to form a continuous passage from the

pharynx to the stomach.

OR

Tracheoesophageal fistula: -

Tracheoesophageal fistula is an abnormal connection between the trachea and the

oesophagus.
INCIDENCE

Incidence: -

Tracheoesophageal fistula occurs in 1 in 3,500 birth.

Approximately 50% of neonates with oesophageal atresia or tracheoesophageal

fistula associated with other anomalies, like- vertebral column defects, cardiac
defects, anorectal malformation etc
ETIOLOGY

Etiology: -
 Exact cause is unknown
 Genetic factor
 Environmental factor
 It may be associated with - vertebral column defects, cardiac defects,
anorectal malformation, trisomy of 21 number of chromosome etc
 TYPES

There are five type of congenital oesophageal atresia with trachea oesophageal fistula are-

Type –I :- Oesophageal atresia

Type –II :- Proximal tracheoesophageal fistula with distal oesophageal atresia

Type –III :- Distal tracheoesophageal fistula with proximal oesophageal atresia

Type –IV :- Both tracheoesophageal fistula

Type –V :- H- type tracheoesophageal fistula

 TYPE –I :- OESOPHAGEAL ATRESIA (8%)

In this type, there is oesophageal atresia and proximal and distal segments of
oesophagus are blind.

There is no communication between trachea and oesophagus.

TYPE –II :- PROXIMAL TRACHEOESOPHAGEAL FISTULA
WITH DISTAL OESOPHAGEAL ATRESIA (3%)

In this type, oesophagus atresia is present and the proximal segment of

oesophagus connects with trachea by a fistula.

The distal end of oesophagus is blind.

TYPE –III :- DISTAL TRACHEOESOPHAGEAL FISTULA
WITH PROXIMAL OESOPHAGEAL ATRESIA (85%)

In this type, oesophagus atresia is present. The proximal end of oesophagus is

blind pouch and distal segment of oesophagus is connected by fistula to trachea.
TYPE –IV :- BOTH TRACHEOESOPHAGEAL
FISTULA (1%)

It is the rarest type that occurs in 1% cases. In this type, both upper and lower
segments of oesophagus communicate with trachea and mild atresia is also
present.
TYPE –V :- H- TYPE TRACHEOESOPHAGEAL FISTULA
(4%)

In this type, oesophagus and trachea are normal and completely formed but are
connected by fistula. There is no atresia in the oesophagus.
PATHOPHYSIOLOGY

• The trachea and oesophagus form together and about the 4 week of gestation,
it is divided into two longitudinal tube into respiratory and digestive tract.

• Due to aetiological factor like- genetic factor, down syndrome, anorectal

malformation etc any problem occurs in separation or incomplete separation
may occur

• Results is tracheoesophageal fistula or oesophageal atresia

CLINICAL FEATURES

 3 ‘C’ signs – coughing, chocking and cyanosis.

 Drooling of saliva

 Respiratory distress

 Abdominal distension

 Aspiration pneumonia

 Regurgitation or vomiting soon after feeding

DIAGNOSTIC FINDINGS

• History collection

• Physical examination

• Chest X-ray

• Tracheobronchoscopy
MANAGEMENT

There is no medical management to treat the congenital malformation

(tracheoesophageal fistula).

Give IV fluid and oxygenation if needed.

Surgical repair:-

Tracheoesophageal surgery required two stages –

Stage-1:- The tracheoesophageal fistula is ligated. And gastrostomy done for

feeding.

Cont………..
Stage-2:- Both proximal and distal end of fistula end to end anastomosis.

IV fluid given in first 24 hours after surgery, following gastrostomy feeding.

Oral feeding may be started from 10th day if the baby's general condition is
good.
NURSING MANAGEMENT

• Observe for chocking, coughing, regurgitation after feeding, abdominal

distension.

• Monitor vital sign for respiratory distress.

• Identify other associated congenital anomaly.

• Clear airway

• Prevention from infection. conti….

• Minimizing pain

• Maintain nutrition pattern of child.

• Reducing parental anxiety

REFERENCE

Book Reference:-
• Pal. P. (2021). Textbook of pediatric Nursing for nursing students. New Delhi. CBS Publishers and
Distributors Pvt. Ltd.

• Sharma. R. (2021). Essentials of pediatric Nursing. New Delhi. Jaypee Brothers Medical Publishers.

• Datta. P. (2016). Textbook of pediatric Nursing. New Delhi. Jaypee Brothers Medical Publishers.

Net Reference:-
• www.medicalexpo.com

• www.Google.com
Thank you