107 Esophageal Atresia Gastrostomy Tube

CASE 107


Clinical Presentation


A newborn presents with respiratory distress and fluid return from the nose and mouth following the first few attempts at swallowing. The abdomen is noted to appear small. Attempts at placing a nasogastric tube failed, and the patient is sent for chest and abdominal radiographs. What should be done for this neonate?


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Figure 107A


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Figure 107B


Radiologic Findings


Chest radiograph shows the nasogastric tube coiled in the upper esophagus (Fig. 107A). Abdominal radiograph demonstrates a gasless abdomen (Fig. 107B).


Diagnosis


Esophageal atresia without evidence of a tracheoesophageal fistula (TEF), requiring definitive repair or gastrostomy tube prior to definitive repair


Differential Diagnosis



  • Upper small bowel atresia
  • Esophageal stenosis

Discussion


Background


Neonates with esophageal atresia may require a gastrostomy tube prior to definitive repair. Traditionally, the tube has been inserted via an open surgical approach. Recently, less invasive techniques for gastrostomy tube insertion, including the percutaneous image-guided gastrostomy, has been used in the pediatric population. The main advantage of this technique is the avoidance of a laparotomy.


In patients with esophageal atresia without TEF, percutaneous gastrostomy tube insertion is problematic. The stomach is small and gasless, and it cannot be inflated as is usually done with a nasogastric tube. Access to the abdomen under radiologic guidance is therefore risky. A novel transhepatic approach is used to instill air into the stomach, which can then permit percutaneous gastrostomy tube insertion under fluoroscopic guidance.


Indications



  • Placing a gastrostomy tube is indicated for enteral nutrition to allow the child to receive appropriate nutrition; therefore, making a primary esophageal repair more successful.

Imaging Findings



  • Ultrasonographic and fluoroscopic guidance are used in this procedure.

Technique

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Dec 21, 2015 | Posted by in PEDIATRIC IMAGING | Comments Off on 107 Esophageal Atresia Gastrostomy Tube

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