Article Text

Download PDFPDF
Mind the gap: delayed diagnosis of oesophageal atresia and tracheo-oesophageal fistula due to passage of a nasogastric tube
  1. Giampiero Soccorso,
  2. Richard J England,
  3. Prasad P Godbole,
  4. Ross M Fisher,
  5. Sean S Marven
  1. Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, UK
  1. Correspondence to G Soccorso, Paediatric Surgical Unit, Sheffield Children Hospital NHS Trust, Western bank, Sheffield, South Yorkshire S10 2TH, UK; giampsoccorso{at}doctors.org.uk

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Two neonates developed sialorrhoea and feeds intolerance. A nasogastric tube (NGT) was passed with difficulty and its gastric position confirmed radiologically in both (figure 1A,B). Oesophageal atresia with tracheo-oesophageal fistula (OA/TOF) was therefore ‘excluded’. However, the babies continued to chock with feeds.

Figure 1

(A, B) In both babies the babygram showed the ‘correct’ position of the nasogastric tube, with the tip lying in the stomach.

A second attempt at inserting a NGT was unsuccessful and further radiographs showed coiled tubes in the upper oesophagus. The oesophageal continuity was tested with a 10 Fr Replogle tube which stopped at about 10 cm from the nostril. Contrast radiographs with the Replogle in place made the diagnosis of OA/TOF in both neonates (figure 2) and confirmed at surgery.

Figure 2

The contrast instilled via the Replogle tube outlined a blind-ending upper oesophageal pouch extending to just below the thoracic inlet. A similar picture was seen in the other baby.

Discussion

Newborns with OA/TOF can tolerate a small NGT that passes through the larynx, the trachea, the fistula/distal oesophagus and reaches the stomach.1,,3

‘Successful’ passage of the NGT is often defined by the length of tube inserted and a pH test, but neither test can exclude passage to the stomach by an abnormal route. An antero-posterior film might highlight a minor deviation from the midline4; a lateral chest x-ray is not routinely indicated. If a baby remains symptomatic in spite of ‘successful’ passage of a NGT, the possibility of OA/TOF should still be considered, a further attempt at passage of a stiff 10 Fr catheter should be undertaken and, where doubt persists, a contrast radiograph should be performed by an experienced radiologist.5

References

View Abstract

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.