Question:

In a long gap oesophageal atresia a contrast study is necessary in the following situations:
1. Routinely, to demonstrate the configuration of the upper pouch at birth
2. Selectively, if the tip of the replogle (suctioning tube) is lying below the level of the 2nd thoracic vertebrae on initial post natal CXR.
3. If gastric output via the tube gastrostomy increases suddenly
4. As a prelude to surgery to determine the gap between the upper and lower pouches
5. On day 1 post repair of oesophageal atresia





Answer:

The correct answers for the question "In a long gap oesophageal atresia a contrast study is necessary in the following situations:" are:

2. Selectively, if the tip of the replogle (suctioning tube) is lying below the level of the 2nd thoracic vertebrae on initial post natal CXR.

3. If gastric output via the tube gastrostomy increases suddenly

4. As a prelude to surgery to determine the gap between the upper and lower pouches



Explanation

Contrast study of the upper pouch is indicated if a perforation by the replogle tube is suspected and is not routinely performed. A sudden increase of gastrostomy output may suggest catheter balloon migration with obstruction and is an indication for a contrast study. In a delayed repair of a long gap oesophageal atresia without fistula a contrast study pre surgery is useful to demonstrate growth of the lower pouch as well as the gap between the oesophageal ends. This information is useful for the surgeon in planning of surgery.



From the manuscript:
A Radiological Chronicle of the Presentation and Management of a Long Gap Oesophageal Atresia
Radiology Case. 2009 Jul; 3(7):17-21


This article belongs to the Pediatric section.




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From the manuscript

A Radiological Chronicle of the Presentation and Management of a Long Gap Oesophageal Atresia

Free full text article: A Radiological Chronicle of the Presentation and Management of a Long Gap Oesophageal Atresia

Abstract
Long gap oesophageal atresia is a clinically and technically challenging condition to manage. Documentation of the gap between the upper and lower pouches is critical to deciding the timing and feasibility of a primary anastamosis. Integral to this process is the role of radiology. We present a case of long gap oesophageal atresia accompanied by chronological radiography demonstrating its` staged management and highlighting some common complications.






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