quiz a complicated TOF case

[Admin]

First correct answer win
A 1800 gram newborn undergoes extrapleural repair of a proximal esophageal atresia and distal tracheoesophageal fistula. On POD 1, she requires emergent reintubation and develops a continuous air leak from the chest tube. Chest x-ray shows a large pneumothorax.

What is the most appropriate management?

A Esophagram

B Switch to HFOV

C Place a second chest tube

D Bronchoscopy

E Reoperation

[Admin]

E. Most likely the tracheal fistula is not sealed well and need to ligate it

The most likely scenario, the emergent reintubation lead to disruption and opening of the ligated fistula and massive air leak, so it need urgent operation to ligate the fistula.
NB: we advise the NICU staff to delay extubation after TOF repair, as a trial to avoid this complication.

[Khant Thant Mg]

E reoperation

[Admin]

E reoperation

Correct, can you justify the answer ?

[Aey]

E. Most likely the tracheal fistula is not sealed well and need to ligate it

[Admin]

E. Most likely the tracheal fistula is not sealed well and need to ligate it

The most likely scenario, the emergent reintubation lead to disruption and opening of the ligated fistula and massive air leak, so it need urgent operation to ligate the fistula.
NB: we advise the NICU staff to delay extubation after TOF repair, as a trial to avoid this complication.

[Farid Elallaghi]

A High risk Patient,My opinion place a second Prophilatic chest tube, if stabile no risk for anaesthesia Reoperate.