[size=20px]A newborn undergoes an extrapleural repair of an esophageal atresia with distal tracheoesophageal fistula. On the second postoperative day he requires reintubation and there is a continuous air leak from the drainage tube. A subsequent chest radiograph reveals a large right pneumothorax.

 

Which of the following is true regarding this patient with esophageal atresia and a large air leak.

 

A bronchoscopy will identify the leak

 

B use of an transanastomotic feeding tube increases the rate of anastomotic stricture

 

C reoperation is the best next step

 

D an esophagram is likely to identify the source of the pneumothorax

 

E extensive esophageal anastomotic disruptions are best treated with cervical esophagostomy[/size]

A

c

Pt intubated and and there is continuous air leak - means there is tracheal fistula.

Edited December 27, 20205 yr by Gunduz Aghayev

D

c

Pt intubated and and there is continuous air leak - means there is tracheal fistula.

correct

 

A continuous air leak from an extrapleural chest tube following reintubation is suspicious for a disruption of the tracheal repair. Reoperation is indicated to close the trachea. Bronchoscopy will not necessarily be able to see the tracheal disruption as one can usually only see the fistula tract and may not be able to see the suture line.

 

Neither extrapleural chest drains nor transanastomotic feeding tubes have been shown to statistically affect the rate of anastomotic complications. An esophagram would identify an esophageal anastomotic dehiscence but not a tracheal dehiscence.

 

Even major esophageal anastomotic disruptions can be treated without diversion, with success being described with both immediate reoperative and conservative management strategies. Major dehiscence recognized within the first 24 to 48 hours is more likely to be amenable to primary repair than dehiscence recognized at a later time. Due to the extensive inflammatory process that develops, a number of alternative approaches have been developed to deal with dehiscences that are not recognized promptly.