Congenital Esophageal Stenosis Associated with Esophageal Atresia and Gasless Abdomen

A radiologically gasless abdomen in a neonate with EA is usually regarded as being pathognomonic of an absence of distal T.E.F. It has been estimated that up to 1.5% of patient with a distal fistula may have a radiologically gasless abdomens as a manifestation of a very small fistula plugged with mucus. In this case a contrast study via the gastrostomy demonstrated a fistula between the distal esophagus with trachea and stenotic area in esophagus. In this patient with congenital esophageal stenosis associated with esophageal atresia (EA), distal tracheoesophageal fistula in presented.The diagnosis of C.E.S associated with EA begins with a high index of suspicion. It is important to verify patency of the distal esophagus at the time of primary anastomosis by passage of a tube to the stomach intraoperatively.The site of stenosis often suggests of etiology. Etiology are classified as: 1) Tracheobroncheal rests most require resection, whereas fibromuscular stenosis and membranous diaphragms usually respond to dilatation alone, hence, are not examined histologically.It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy and pH monitoring. That patient is now 2 year old is asymptomatic with a normal esophagram and eating a normal diet.