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Congenital tracheoesophageal fistula (TOF) is a rare anomaly. With the development of endoscopic techniques, the diagnosis of TOF has made marked progress. It requires surgical repair in infancy by either open or thoracoscopic approach. Diagnosing and locating the location of fistula may be difficult particularly in smaller fistula. We report three cases of TOF, to highlight the role of bronchoscopy and endoscopy and also the challenges in managing the aforementioned cases, which may present with airway embarrassment.

Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. However, we diagnosed oesophageal atresia with distal Tracheoesophageal fistula on the 2nd day as nasogastric tube insertion was failed beyond 10cm and confirmed by X-ray with a rubber catheter. Right thoracotomy with ligation of the fistula with end to end anastomosis was performed successfully without complications. Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.

Objectives Recurrent congenital tracheoesophageal fistula (TEF) is well documented in infancy but may also present later in life. This study reviews our experience with the clinical presentation, diagnosis and management of 5 recurrent and 2 primary congenital tracheoesophageal fistulas (TEF) in adult patients. There are no literature series of late recurrence of TEF (repaired in childhood and recurring in adulthood) and relatively few reported cases of initial adult presentation of TEF. In this series, we aim to provide the first large series description of late recurrence of congenital TEF following repair in infancy or childhood. We also present management considerations for this unique group of patients. Methods We performed a computer-based search of the adult thoracic surgery departmental operative database at our institution from 2002 to 2014. Patients with iatrogenic TEF or malignant TEF were excluded. Results Seven patients are included in our series. Five patients (71%) had recurrent congenital TEF and 2 (29%) had initial diagnosis of congenital TEF. All presented with severe coughing symptoms, and most (86%) had a history of recurrent aspiration pneumonia. Repair technique was dictated by the location of the TEF and the specific tracheoesophageal pathology. Four patients underwent repair via cervical approach with or without a tracheal resection. Three patients with distal recurrence underwent repair via right thoracotomy with partial oesophagectomy for significant tissue compromise and cervical reconstruction. Patients were followed for at least 1 year. All 7 patients experienced full resolution of symptoms. One patient required postoperative placement of a retrievable tracheal stent for tracheomalacia. There were no mortalities. Conclusions Adult presentation of congenital TEF is a rare but recognizable clinical entity. Recurrent TEF in adulthood is a possible late complication of TEF repair performed in childhood that has not previously been described. Adult patients experiencing symptoms of cough and recurrent aspiration pneumonia should be evaluated for congenital TEF. Surgical repair of congenital TEF in the adult is feasible and effective with acceptable morbidity.

A tracheal pouch is a rare complication of successful repair of a congenital tracheoesophageal fistula (TEF). An 18-month-old child with a repaired congenital TEF was scheduled for esophageal dilation to treat his esophageal stricture. Migration of the distal end of the endotracheal tube into a previously undetected tracheal pouch caused an abrupt failure to ventilate at the end of surgery. Given our experience, we recommend to screen the trachea of every patient with corrected TEF for a tracheal pouch when they are scheduled for another procedure requiring general anesthesia.

From the *Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada; †Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH; and ‡Department of Anaesthesia, The Tweed Hospital, Tweed Heads, Australia. Address reprint requests to Anthony M.-H. Ho, MD, FRCPC, FCCP, Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, Ontario, Canada, K7L 2V7. E-mail: hoamh@hotmail.com © 2016 Elsevier Inc. All rights reserved. 1053-0770/2601-0001$36.00/0 http://dx.doi.org/10.1053/j.jvca.2015.04.005

Objective: To examine the prevalence of upper airway anomalies in patients diagnosed with congenital tracheoesophageal fistula and esophageal atresia (TEF/EA). Methods: A retrospective review was conducted of all TEF/EA patients seen at a tertiary pediatric hospital between January 2008 and December 2013. Inclusion criteria included evaluation by the otolaryngology service. Exclusion criteria included age >18 years, acquired TEF/EA, subsequent rule out of TEF/EA, and otolaryngology evaluation for reasons not pertaining to the airway. Data collected and analyzed included demographics, comorbidities, presenting symptoms, surgical interventions, laryngoscopic and bronchoscopic examinations, and subsequent medical and surgical management. Results: Four hundred and thirty patients were diagnosed with TEF/EA at our institution. In all, 32.3%, or 139 children, were included in the analysis; 56.1% (n = 78) male, 43.9% (n = 61) female. Of the analyzed patients, 4.3% (n = 6) were diagnosed with laryngomalacia. Eighteen patients (12.9%) were diagnosed with subglottic stenosis. Thirty (21.6%) had vocal fold paresis or immobility. Laryngeal cleft was diagnosed in 25.9% (n = 36). Tracheomalacia was the most common airway finding, diagnosed in 37.4% (n = 52) patients. Conclusion: Patients diagnosed with congenital TEF/EA have a high rate of secondary upper airway anomalies. Consideration should be given to perform a complete airway evaluation in all of these patients.

Purpose Open repair with a second thoracotomy is technically challenging and has a high risk of complications for the treatment of a recurrent tracheoesophageal fistula (RTEF). Therefore, less invasive endoscopic techniques have been developed. Here, we report on the chemocauterization with trichloroacetic acid (TCA) technique for endoscopic management of RTEF. Methods Three patients who had an open repair with thoracotomy for congenital tracheoesophageal fistula and were diagnosed with RTEF were included in this study. Rigid ventilating bronchoscopy with telescopic magnification was used to evaluate and manage the RTEF. After identification of the fistula opening, a 50% TCA-soaked small cotton ball was applied in the opening 3 times during each session. Results The mean number of procedures was 3.3, and the fistulae were closed in all cases. Closure of the fistula was confirmed by esophagogram and/or bronchoscopy. There were no postoperative complications. Conclusion The results of this study showed that chemocauterization with TCA can be safe and effective for the management of RTEF.

Summary Objective Recurrent tracheoesophageal fistula (TEF) is a difficult problem in both diagnosis and management. Revision open repair with thoracotomy is challenging and has a significant associated morbidity. Because of the technical difficulty and the substantial morbidity, several authors have suggested and implemented endoscopic management. This paper reviews and describes the endoscopic techniques and management of recurrent TEF. Methods This retrospective study evaluates three patients who underwent endoscopic (bronchoscopic) management of recurrent TEF at Children's Memorial Hospital in Chicago, Illinois. Median follow-up is 48 months. A current literature review is presented with a synthesis of the data on techniques and results. Results Two of the three patients had successful bronchoscopic closure using fibrin adhesive. The mean number of procedures required was two. Including these patients, 62 patients with endoscopic closure of congenital TEF have been reported in the literature. The overall success rate is 60% with a mean of 2.1 procedures per patient. Of the obliterating agents described, tissue adhesive and fibrin adhesive have been employed most frequently with success rates of 48 and 55%, respectively. Conclusion Endoscopic repair of recurrent TEF is an effective and safe alternative to second thoracotomy and open surgical repair. More than one endoscopic procedure is usually necessary for successful closure.

症例は39歳女性. 検診時胃カメラで食道前壁に瘻孔を認め, 当院紹介となる. 食道内視鏡で食道前壁に憩室を伴う瘻孔を認め, 気管支鏡にて気管膜様部に瘻孔を認めた. 胸部CTにて第2胸椎レベルで拡張した食道と気管に交通を認めた. 以前より経口摂取時にむせやすく小児期に肺炎を繰り返していたことより先天性食道気管瘻と診断し, 開胸下に瘻管離断術を施行した. 術後1年を経過した現在, 自覚症状は消失しており再開通の所見は認めていない. 成人期発見の先天性食道気管瘻は稀であり文献的考察を加え報告する.

Congenital H-type tracheoesophageal fistula (TEF) in adults is a rare presentation and can test the diagnostic acumen of a surgeon, endoscopist, and the radiologist. These undetected fistulas may present as chronic lung disease of unknown origin because repeated aspirations can lead to recurrent lung infections and bronchiectasis. Congenital TEFs should be considered in the diagnosis of infants and young adults with recurrent respiratory distress and/or infections. Here, we present the successful management of this rare case in an adult patient.

Les auteurs rapportent 2 cas de fistules oesotracheales isolees sans atresie de l'oesophage, colliges au service de chirurgie pediatrique au CHU Hassan II de Fes au Maroc entre 2008 et 2013. Il s'agit d'une anomalie rare representee par un fin canal ascendant entre l'oesophage et la face posterieure de la trachee, a la hauteur du defile cervico-thoracique. Elle se manifeste cliniquement par une symptomatologie respiratoire parfois digestive. Le diagnostic a ete confirme par le transit oesophagien dans les 2 cas et a permis aussi de determiner le siege de la fistule. Le traitement etait chirurgical, il a permis de supprimer la communication anormale entre l'oesophage et la trachee par un abord cervical avec interposition musculaire dans les 2 cas. Les suites post-operatoires et l’evolution a long terme etaient simples. Le but de ce travail est d'exposer les differents moyens diagnostique et therapeutique.

Introduction: Congenital tracheoesophageal fistula without esophageal atresia (H-type TEF) is an unusual entity that typically presents in the first months of life with clinical signs of a...

La fístula traqueo-esofágica (FTE) en H representa el 3-6% del total de las FTE congénitas. En las últimas décadas se está llevando a cabo su tratamiento de forma endoscópica, con aplicación de diversos materiales tras cauterización o no del trayecto fistuloso. Esta técnica se ha extendido por ser menos invasiva que el abordaje quirúrgico tradicional, la toracotomía. No se han publicado complicaciones con los procedimientos endoscópicos, no obstante aun no existe un material ideal. Presentamos un caso de FTE en H, en el que varios días después de haber realizado el tratamiento endoscópico con cepillado y aplicación de cianoacrilato, se produjo el desprendimiento del material y su posterior impactación en la tráquea., H-shaped tracheoesophageal fistula (TEF) represents 3% to 6% of all congenital TEF. On the last decades, a new endoscopic approach has been developed to treat this condition using different materials. The use of this technique is increasing because of its less invasive nature. No postoperative complications have been published yet, although no particular material has proven to be ideal to ensure the permanent sealing of the fistulous tract. We report one patient presenting with H-shaped TEF, endoscopically treated with brushing and sealing of the fistula with cyanoacrylate. We present the first postoperative complication with this endoscopic approach ever described in the literature, an airway obstruction secondary to migration of the material to the trachea.

Congenital tracheoesophageal fistula (TEF) without esophageal atresia (H-type) is a rare condition in adult patients (1). TEF presents in the form of frequent respiratory infections, coughing episodes when eating or drinking, paroxysmal cough and hemoptysis. Surgical repair with thoracotomy is the standard management for TEF (2). Endoscopic repair of TEF is an effective and safe alternative to repeat thoracotomy and open surgical repair (3). More than one endoscopic procedure is usually necessary for successful closure. The present report describes a transesophageal technique for endoscopic submucosal resection and clip occlusion of H-type TEF in an adult. We suggest this approach as an alternative method for treating TEF.

A case of a three-year-old male child who was admitted to our hospital with the suspicion that he had swallowed a battery approximately one hour before admittance. The parents believed that it was a button-shaped lithium battery approximately 12 mm in diameter. A chest X-ray was taken immediately, and a battery was identified in the esophagus at the fifth thoracic vertebra. By reviewing the child’s medical history, we found that the child had had surgery the day after birth due to congenital atresia of the esophagus and a tracheoesophageal fistula type III b. An esophagoscopy was performed one hour after admittance, and the battery was found to be partially past the scar from the first surgery. Because of that, the battery was pushed further toward the stomach, out of fear that retrieving the battery through the scarred section of the child’s esophagus could damage the stenotic wall. Upon the next X-ray of the abdomen, the battery was observed in the stomach. The child was monitored, and X- rays were taken over the next several days. The battery was evacuated in stool eight days after it had been ingested.

In 3 patients, recurrent respiratory symptoms after neonatal repair of congenital tracheoesophageal fistula (Gross type C in 2, D in 1) were associated with a large tracheal remnant of the fistula termed diverticulum. Symptoms resolved after resection of the diverticulum in 1 child with airway obstruction and 1 adult with recurrent tracheoesophageal fistula.

Tracheoesophageal fistula (TEF) or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bron-choesophageal fistula is usually associated with eso-phageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.

Congenital tracheoesophageal fistula without atresia can persist and remain undetected without symptoms until adulthood. We have recently encountered such a rare case and also conducted a review of the literature. Symptoms are commonly present during infancy, but occasionally patients do not develop symptoms until adulthood. In this case, it is suggested that the symptoms commenced after the redundant mucosal flap or membrane was broken due to a trauma to the chest.

Three newborns with congenital tracheoesophageal fistula were treated by endoscopic laser coagulation. After radiologic and endoscopic diagnosis, laser coagulation of the mucosal layer of the fistula followed using Nd:YAG laser light transferred through an uncovered quartz fiber of 600 microns diameter. The successful and uneventful course in two cases contrasts with the incomplete obliteration in one case caused by inadequate energy application and/or early localized instillation of contrast medium for radiologic control examination. The advantages of this method include elimination of an operative procedure, exclusion of operative complications, and the possibility of repetition in recurrent cases. Care must be taken to prevent esophageal and tracheal damage by use of this method.

Recurrent tracheoesophageal fistula is a major complication of surgical therapy among children with congenital esophageal atresia and tracheoesophageal fistula. In a consecutive series of 153 patients operated on during a 20-year period in the same institution, only one patient had this complication. The authors believe that adherence to sound surgical principles can lower the risk of fistula recurrence considerably.

The authors successfully treated an adult with congenital tracheoesophageal fistula (TEF) Gross-C type by the addition of an effective pedicled muscle flap. This patient had undergone 2 thoracotomies when he was an infant at another hospital; however, the fistula recurred. After transection and closure of the fistula, a right rectus abdominis muscle flap between the 2 stumps was interposed. The current case followed a favorable postoperative course; neither fistula nor abdominal hernia occurred.

H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation.