Tracheoesophageal Fistula

Introduction:

Tracheoesophageal fistula (TEF)is the congenital anomaly where there is abnormal fistulous connection between trachea & esophagus.The incidence of TEF is 1 in 2000-4000 live births.

Associated Anomalies:

Duodenal atresia
Down syndrome,
Ventricular septal defect

Age:

Congenital Tracheoesophageal fistula (TEF) present immediately after birth. H-type of fistula may present in neonates or in infancy.

Classification:

Type 1- Esophageal atresia with distal TEF - 87%
Type 2- Isolated esophageal atresia without TEF - 8%
Type 3- Isolated TEF-4%
Type 4- Esophageal atresia with proximal TEF-1%
Type 5- Esophageal atresia with proximal and distal TEF-1%

Symptoms:

1. Copious white frothy secretions comes out through mouth.
2. Coughing & choking while taking breast feed
3. Cynosis
4. increased respiratory rate

Diagnosis:

1. Plain X-ray chest shows coiling of infant feeding tube in mediastinum.
2. Stomach bubble is not seen in pure esophageal atresia
3. 2-D Echo- for associated cardiac anomalies
4. Ultrasonography of abdomen- to exclude renal / other abdominal anomalies

Treatment:

Thoracotomy, division of fistula & esophago-esophageal anastomosis is the primary line of treatment. If the child is premature with low birth weight & respiratory distress syndrome then one can do the staged procedures. Initially gastrostomy & esophagostomy. After stabilization primary repair. In pure esophageal atresia, initially gastrostomy & esophagostomy then esophageal replacement by gastric pull up,reverse gastric tube, colon transposition or ileal transposition.