Some functional characteristics of the oesophageal vestibule in infants and children.

The oesophageal vestibule lies immediately above the stomach and during quiet respiration is located partly in the thorax, partly in the hiatus in the diaphragm, and partly in the abdomen. An analysis of some aspects of function of the vestibule in infants and children who have a non-contractile gullet above the vestibule is presented. Opening of the vestibule is related to deglutition and is independent of the oesophagus above. In its opening and closing the vestibule is shown to have the characteristics of a 'muscle throttle'. The rapidity of the event of either opening or closing is accounted for. The important relationship of calibre of lumen of the vestibule to flow through it is analysed. The effect of the indentations of mucosa into the lumen when the vestibule is partially open is analysed from a theoretical standpoint, and it is inferred that the vestibule when only partially open has the characteristics of a highly efficient choke. The vestibule lies at the lower end of the oesophagus immediately proximal to the stomach. Normally, part of the vestibule lies in the abdomen , part in the diaphragmatic hiatus, and a part, during quiet respiration, lies in the thorax. In the normal infant or child radiological studies of the function of the vestibule are handicapped by the direct effects of deglutition and the presence of an oesophageal stripping wave emptying the oesophagus of its content after deglutition. Paediatric radiological practice provides the opportunity of assessing vestibular function in the absence of a stripping wave and also when the direct effect of deglutition can be excluded. PATIENTS STUDIED Four groups have been included in the present study: Group 1 Tracheo-oesophageal fistula: Two patients with an absence of oesophageal stripping action who had had no operative treatment. Group 2 Post-repair of oesophageal atresia: Four patients were examined, none of whom showed an oesophageal stripping wave. In effect, this repair is a repair of an oesophageal transection. In three of the four a small fixed sliding type hiatal hernia was present. Group 3 Colon transplantation for oesophageal atresia with the transplant interposed between short upper and lower oesophageal segments: Six patients were examined; no mass movements were observed in the transplant at the time of the examination. Group 4 Colon transplant with a lower anasto-mosis between the lower oesophageal segment and the transplant: Proximally the colon had been exterior-ized on the left side of the neck …