GI Radiology > Esophagus > Congenital Esophageal Anomalies

Congenital Esophageal Anomalies

Tracheoesophageal Fistulas


Congenital tracheoesophageal (TE) fistulas result from failure of the esophageal lumen to develop completely separate from the trachea. Embryonically, the trachea and upper GI tract have a common origin at the caudal end of the embryonic pharynx. In normal development during the second month of gestation, the esophagus assumes a dorsal position, while the trachea lies ventrally. Failure of this complete separation leads to the development of TE fistulas. Below is a diagram depicting the different type of congenital TE fistulas and their frequency of occurrence. Esophageal atresia (EA) is a common cause of polyhydramnios in utero. At birth, the infant may have difficulty handling secretions and may have respiratory distress at first feeding. Attempts to pass a nasogastric tube are usually unsuccessful. Infants with TE fistulas tend to have rounded abdomens and bowel sounds, while those with EA without a fistula tend to have scaphoid abdomens and absent bowel sounds.

Radiological findings

For patients with EA and no TE fistula, barium studies are performed through a gastrostomy tube to define the length of the lower esophageal segment before surgery. In patients with proximal fistulas, nonionic water-soluble contrast is injected through a feeding tube in the upper esophageal pouch.

In image "A" we can see atresia of the upper esophagus as evidenced by failure to pass a feeding tube down the esophagus, but we still observe gas in the abdomen. These findings are likely due to a esophageal atresia with a distal tracheoesophageal fistula. Images "B, C, D" show contrast filling a blind pouch.


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