Symposium on Pediatric Surgery
Esophageal Atresia and Tracheoesophageal Fistula Malformations
Keith W. Ashcraft, M.D.,* and Thomas M. Holder, M.D.t
The embryologic development of the trachea and esophagus has been studied by many but the mechanisms of malformation which result in esophageal atresia and tracheoesophageal fistula deformities are still not clear. At about the 21st day of embryonic development the foregut begins to form into the dorsal esophagus and the ventral trachea. The two organs are separated by a process of septation beginning at about the carina and extending cranially toward the larynx. It is believed by some that an interruption in the septation process between days 24 and 28 would result in a fistula between the esophagus and the trachea. An early "interruption" would thus result in a lower fistula while a disturbance in the septation process occurring later might result in a higher fistula. The reader is referred to the excellent article by Smith29 and to the chapter by Hopkins16 for more details on embryology. It is in any case suggested that the disturbance which produces these esophageal deformities is a generalized one because frequently associated with esophageal atresia are vertebral anomalies, cardiac lesions, duodenal atresia, imperforate anus, and genitourinary anomalies. All of these organ systems appear to be developing rapidly at the time that the esophagus and trachea are dividing, lending evidence to the concept that a systemic insult to the embryo is responsible. Although there have been sporadic cases of siblings being born with esophageal atresia, it is also true that one member of a set of twins may be affected while the other is normal. There is no known pattern of heritability. From the Department of Surgery, University of Missouri, Kansas City, School of Medicine and the Children's Mercy Hospital, Kansas City, Missouri
*Associate Clinical Professor of Surgery t Clinical Professor of Surgery Surgical Clinics of North America- Vol. 56, No.2, April 1976
299
300
EA WITH DISTAL TEF 87%
KEITH
ISOLATED EA 8%
W.
ASHCRAFT AND THOMAS
ISOLATED TE F 4%
EA WITH PROXIMAL TEF
Esophageal Atresia and Tracheoesophageal Fistula Malformations
Keith W. Ashcraft, M.D.,* and Thomas M. Holder, M.D.t
The embryologic development of the trachea and esophagus has been studied by many but the mechanisms of malformation which result in esophageal atresia and tracheoesophageal fistula deformities are still not clear. At about the 21st day of embryonic development the foregut begins to form into the dorsal esophagus and the ventral trachea. The two organs are separated by a process of septation beginning at about the carina and extending cranially toward the larynx. It is believed by some that an interruption in the septation process between days 24 and 28 would result in a fistula between the esophagus and the trachea. An early "interruption" would thus result in a lower fistula while a disturbance in the septation process occurring later might result in a higher fistula. The reader is referred to the excellent article by Smith29 and to the chapter by Hopkins16 for more details on embryology. It is in any case suggested that the disturbance which produces these esophageal deformities is a generalized one because frequently associated with esophageal atresia are vertebral anomalies, cardiac lesions, duodenal atresia, imperforate anus, and genitourinary anomalies. All of these organ systems appear to be developing rapidly at the time that the esophagus and trachea are dividing, lending evidence to the concept that a systemic insult to the embryo is responsible. Although there have been sporadic cases of siblings being born with esophageal atresia, it is also true that one member of a set of twins may be affected while the other is normal. There is no known pattern of heritability. From the Department of Surgery, University of Missouri, Kansas City, School of Medicine and the Children's Mercy Hospital, Kansas City, Missouri
*Associate Clinical Professor of Surgery t Clinical Professor of Surgery Surgical Clinics of North America- Vol. 56, No.2, April 1976
299
300
EA WITH DISTAL TEF 87%
KEITH
ISOLATED EA 8%
W.
ASHCRAFT AND THOMAS
ISOLATED TE F 4%
EA WITH PROXIMAL TEF
