Letters to the Editor

Indian Pediatrics 2000;37: 1287.

Pitfalls in the Diagnosis of Esophageal Atresia

I read with interest the communication on this subject(1). While I agree that the use of a soft catheter can be misleading, I would like to add a word of caution while using a stiff catheter.

The use of a stiff catheter can result in one of the following possibilities: (i) Uneventful passage into the stomach through a normal esophagus, ruling out esophageal atresia; (ii) Hold up in the upper pouch confirming esophageal atresia; (iii) Iatrogenic perforation of a normal esophagus producing a clinical picture that mimics esophageal atresia(2) a false positive situation; and (iv) Iatrogenic perforation of the upper pouch in a case of esophageal atresia, with the catheter passing through the mediastinum into the abdomen, thus clinically and radiologically ruling out esophageal atresia - a false negative situation.

I have been involved in the management of a neonate who remained "mucousy" after successful passage of a nasogastric tube, confirmed radiologically. The tube was removed and attempts at re-insertion failed. A contrast study confirmed esophageal atresia and the baby was taken up for thoracotomy, ligation of fistula and primary end to end anastomosis. The blind upper pouch was found to have a tiny perforation, which was incorporated in the anastomosis. The baby showed an uneventful recovery.

The earlier X-ray was reviewed. We now noticed that the NG tube had taken a straight, almost direct path through the mediastinum instead of following the gentle curve of the normal esophagus.

Though a stiff catheter should be used when looking for an esophageal atresia, the maneuver should be very gentle. Awareness of the possibility of perforation will help in avoiding this complication. Also, if the catheter passes into the abdomen, it lies in the thorax should be observed radiologically to rule out an iatrogenic perforation.

Anurag Kumar,
Consultant Surgeon,
TELCO Hospital,
Jamshedpur, India.

1. Gupta A, Narasimhan KL. Pitfalls in the diagnosis of esophageal atresia. Indian Pediatr 2000; 37: 801-802.

2. Pumberger W, Bader T, Golej J, Pokieser P, Semsroth M. Traumatic pharyngo-esophageal perforation in the newborn: A condition mimicking esophageal atresia. Pediatr Anesth 2000; 10: 201-205.