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Anomalies Of The Esophagus

Sources: 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

few weeks.

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.

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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forceps, which is then withdrawn with opened blades.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.