Congenital Atresia of the Œsophagus

ALTHOUGH congenital atresia of the cesophagus is comparatively rarely diagnosed, it is, as will be shown, a not uncommon congenital anomaly, and since early treatment now offers a chance of complete cure we have felt it worth while to make the following short summary of the literature on the subject, with notes on the clinical appearances of typical cases. The condition has been reported in the literature for at least 250 years, Mackenzie (1884) quotes a case recorded by Durston in 1670. However, the earlier reports were largely of academic interest, and cases with successful operative repair were not recorded in any number until 1944. In that year, Haight (1944) reported 32 cases, 24 of which were explored surgically; in 16 the cesophagus was reconstructed, and 6 of these infants survived seven months or longer. Daniel (1944) reported 7 cases; all were explored-in 2 the segments were united, 1 child survived. Lam (1945) recorded 25 successful results of either single or multiple stage operation, and added 3 more cases of his own. Since then numerous series, large or small, have been reported with progressively better operative results. In all these, stress has been laid upon the need for early diagnosis, since delay in operation beyond the first twenty-four hours of life has been accompanied by a marked rise in mortality (Weiner and Richmond, 1950) (Ladd and Swenson, 1947), although successful results have been obtained even when operation has been delayed until the fourth day of life (White and Birdsong, 1946). CLINICAL DIAGNOSIS. The condition may be suspected within a very short time after delivery, even before any feeds have been given, in an infant who shows cyanosis, with copious frothy saliva, which continues or increases. Belsley and Donnison (1950) advise that such infants should be given nothing by mouth until this anomaly has been excluded by passing a catheter into the stomach. If feeds are offered to these infants inadvertently they will return the feed as soon as a few mouthfuls have been taken, often becoming cyanosed at the same time. Where this occurs, it is essential that no more should be given until the child has been carefully examined to confirm or exclude the presence of cesophageal atresia. Clinical signs of atelectasis, especially of the right upper lobe may be present, and this is not necessarily due to aspiration of feeds, since it may be present before any food …