Chairman Neuhauser: I have been very much impressed with the pediatricians who know much more about diseases and abnormalities of the heart and lungs than they give themselves credit for, but the roentgen manifestations of abnormalities of the gastrointestinal tract do not appear to be as well understood. Many of the lesions that occur in the gastrointestinal tract, even the common ones, are overlooked. An understanding of the simple lesions and many of the more complicated ones is essential if the proper roentgen examination is to be carried out.
Most of the congenital malformations that occur have a rather simple embryologic explanation. There is defective recanalization of the fetal gut. When the fetal gut is first formed it is an open tube, but during the first few weeks of fetal life there is proliferation of the epithelial lining cells with obliteration of the lumen. Recanalization promptly ensues.
Many of the abnormalities occur during this process of recanalization. Stenosis, atresia, diverticular, duplication and many of the fistulas have their origin during this period of recanalization. The very simple lesions of stenosis and atresia are best demonstrated by lantern slides.
Tracheo-esophageal fistula without atresia or stenosis of the esophagus is not at all uncommon. Many are overlooked because the condition is not suspected; others may be overlooked because the roentgen examination is not properly carried out. Certainly a fistula between the esophagus and trachea running obliquely upward from the anterior aspect of the upper third of the esophagus to the trachea cannot be visualized if the patient is examined only in the supine or prone position.
- Copyright © 1953 by the American Academy of Pediatrics