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Anomalies Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Congenital esophagotracheal fistulae are the most frequent of the
embryonic developmental errors of this organ. Septic pneumonia from
the entrance of fluids into the lungs usually causes death within a
Imperforate esophagus usually shows an upper esophageal segment
ending in a blind pouch. A lower segment is usually present and may be
connected with the upper segment by a fistula.
Congenital stricture of the esophagus may be single or multiple, and
may be thin and weblike, or it may extend over a third or more of the
length of the esophagus. It may not become manifest until solids are
added to the child's diet; often not for many months. The lodgment of
an unusually large bolus of unmasticated food may set up an
esophagitis the swelling of which may completely close the lumen of
the congenitally narrow esophagus. It is not uncommon to meet with
cases of adults who have never swallowed as well as other people,
and in whom cicatricial and spasmodic stenosis can be excluded by
esophagoscopy, which demonstrates an obvious narrowing of the
esophageal lumen. These cases are doubtless congenital.
Webs in the upper third of the esophagus are best determined by the
passage of a large esophagoscope which puts the esophagus on the
stretch. The webs may be broken by the insertion of a closed alligator
forceps, which is then withdrawn with opened blades. Better still is
the dilator shown in Fig. 26. This retrograde dilatation is relatively
safe. A silk-woven esophagoscopic bougie or the metallic tracheal
bougie may be used, with proper caution. Subsequent dilatation for a
few times will be required to prevent a reproduction of the stenosis.
Treatment of Esophageal Anomalies.--Gastrostomy is required in the
imperforate cases. Esophagoscopic bouginage is very successful in the
cure of all cases of congenital stenosis. Any sort of lumen can be
enlarged so any well masticated food can be swallowed. Careful
esophagoscopic work with the bougies (Fig. 40) will ultimately cure
with little or no risk of mortality. Any form of rapid dilatation is
dangerous. Congenital stenosis, if not an absolute atresia, yields
more readily to esophagoscopic bouginage than cicatricial stenosis.
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