Pediatric surgery. Obstruction of the esophagus. Diagnostics (most important)

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Pediatric surgery. Obstruction of the esophagus. Diagnostics (most important)

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12. Obstruction of the esophagus. Diagnostics

With exhaustive completeness and reliability, the diagnosis is made on the basis of an X-ray examination of the esophagus using a contrast agent, which is carried out only in a surgical hospital. The data obtained are a necessary part of the preoperative examination and serve as a guideline for choosing the method of surgical intervention. X-ray examination of children with suspected esophageal atresia begins with a plain chest radiograph.

Then, a rubber catheter is passed into the upper segment of the esophagus and the mucus is sucked off, after which 1 ml of iodo-lipol is injected through the same catheter into the esophagus with a syringe. The introduction of a large amount of iodized oil can lead to an undesirable complication - overflow of the blind upper segment of the esophagus and aspiration with filling of the bronchial tree with a contrast agent.

Pictures are taken in the vertical position of the child in two projections. The contrast agent after X-ray examination is carefully sucked off.

The use of barium sulfate as a contrast agent for examination of the esophagus in newborns with any form of atresia is contraindicated, since its entry into the lungs, which is possible during this study, causes atelectatic pneumonia.

In the general serious condition of the child (late admission, prematurity III-IV degree), you can not undertake examinations with a contrast agent, but limit yourself to the introduction of a thin rubber catheter into the esophagus (under the control of an X-ray screen), which will allow you to fairly accurately determine the presence and level of atresia. It should be remembered that with the rough introduction of a low-elastic thick catheter, the pliable film of the blind oral segment of the esophagus can be displaced, and then a false impression is created about the low location of the obstruction.

A characteristic radiological symptom of esophageal atresia when examined with a contrast agent is a moderately dilated and blindly ending upper segment of the esophagus. The level of atresia is more accurately determined on lateral radiographs.

The presence of air in the gastrointestinal tract indicates an anastomosis between the lower esophagus and the respiratory tract.

The visible upper cecum and the absence of gas in the gastrointestinal tract suggest atresia without a fistula between the distal esophagus and the trachea. However, this radiographic finding does not always completely rule out a fistula between the distal esophagus and the airways.

The narrow lumen of the fistula is clogged with a mucous plug, which serves as an obstacle to the passage of air into the stomach.

The presence of a fistula between the upper segment of the esophagus and the trachea can be detected radiologically by throwing a contrast agent through the fistula into the respiratory tract. This examination does not always help to detect a fistula.

Authors: Drozdov A.A., Drozdova M.V.

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