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Background. For patients with locally advanced esophageal carcinoma, tracheal involvement is common, and the formation of a tracheoesophageal fistula is a frequent complication of the disease, with or without treatment. However, the presence of a tracheoesophageal fistula has historically been considered a relative contraindication to radiation therapy. Therefore, we are presenting a case report whereby irradiation was continued despite the presence of such a fistula. Methods. A 60-year-old white man diagnosed with Stage III, T4NOMO, moderately well-differentiated invasive squamous cell carcinoma of the esophagus was initially treated with four courses of chemotherapy (5-fluorouracil and cisplatin) and had an excellent tumor response. He was then referred for consolidative radiation therapy (XRT). At 600 cGy, he had symptoms consistent with a tracheoesophageal fistula (TEF), which was documented by barium swallow at 3000 cGy. Radiation treatments were continued, but at a reduced fraction size that was gradually increased over several days. Results. Upon completion of the radiation therapy, the TEF persisted but had completely disappeared 2 months post-XRT. However, at 4 months post-XRT, the fistula recurred due to tumor recurrence. At 6 months post-XRT, he died with metastatic disease, 16 months after initial diagnosis and 8.5 months after the first TEF occurred. Conclusions. The presence of a TEF may not be an absolute contraindication to radiation therapy. Radiation therapy may be initiated or continued in the presence of a TEF, and eventual resolution of the fistula may occur. Recurrence of a healed TEF may indicate recurrence of a tumor.

Cleft larynx is a relatively rare congenital problem which stems from an incomplete development of the wall that normally separates the larynx (voice box) and the esophagus. The condition was first described in 1792, but the number of known cases had grown to only 33 by 1974. However, in a summary article in 1985, 129 cases had been reported. Most cases end in death, as these children usually have other severe abnormalities which further complicate their survival. The present study presents the case of a child who was diagnosed with a cleft larynx at 13 days of age; surgical repair was performed at 17 days. The larynx and esophagus, which had communicated via a horseshoe-shaped defect, was closed, but a defect was found again 14 days following surgery. When a tracheotomy was performed, the child's deteriorating condition improved markedly. At 44 days, the child underwent a second operation to close the defect and the infant did very well. However, six weeks later, a small communication (fistula) was found between the trachea and esophagus. This was repaired by endoscopy (an instrument was inserted down the trachea, which allowed the surgeon to visualize the defect) by cauterizing the wall between the trachea and esophagus. At the time of this report the child is 15 months old and is nourished by tube feedings through a gastrostomy (tube is inserted into the stomach through the abdominal wall), and breaths through a tracheostomy (a breathing tube in her neck) which should shortly be removed. The embryology and pathology of cleft larynx is discussed in this review article. The literature and the authors' experience suggest that children with this condition should undergo tracheostomy in order to stabilize their breathing. As this condition is frequently associated with multiple defects, a comprehensive examination is required; it is particularly important to include an evaluation that will image tracheo-esophageal fistulas. A multidisciplinary medical team that thoroughly understands the embryology and surgical repair is extremely important to overcome the high mortality associated with laryngeal cleft. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acquired Tracheoesophageal Fistula (TEF) is a life threatening condition and usually occurs secondary to trauma or invasion of anatomic structures in the mediastinum by neoplasm. It is uncommon for infants to ingest articles large enough to produce esophageal damage. Failure to diagnose foreign body ingestion in a timely manner can allow time for erosion into the wall of the esophagus with subsequent profound injury to the esophagus, the trachea or both. We present a case of plastic lollipop ring ingestion in a 10-month-old infant resulting in acquired TEF. The importance of communication between the surgeons and the anesthesiologists prior to definitive operative procedure as well as during repair of a traumatic injury to the trachea is stressed. Acquired TEF in an infant can be a life threatening emergency and the anatomic relationships and plans for the worst-case scenario should be reviewed prior to taking the infant to the operating room. Keywords: Pediatric Anesthesia, Tracheoesophageal fistula, Infant, Table of Contents Abstract Case Report Discussion References Case Report A previously healthy, ten month old female infant weighing 9.6 kg was admitted for respiratory distress. This was her fourth [...]

A 'gasless abdomen' in babies with esophageal atresia (EA) has traditionally been thought to imply absence of a distal tracheoesophageal fistula (TEF). We present 2 cases with gasless abdomen and later turned out to be cases of esophageal atresia with tracheoesophageal fistula. These cases are presented because of its extreme rarity and because of ease in management if the condition is diagnosed preoperatively., Table of Contents Abstract Introduction Case 1 Case 2 Discussion References Introduction A gasless abdomen in a neonate with esophageal atresia (EA) implies the absence of a distal tracheoesophageal fistula [...]

Traumatic tracheo-oesophageal fistulas occur secondary to either blunt trauma or open avulsion injury to the neck and thorax. It can occur following prolonged endotracheal tube intubation, as a complication of tracheostomy and improper positioning of tracheostomy tube. Tracheo-oesophageal fistulas following ingested or inhaled foreign bodies are very rare and in majority of these cases they present as an acute condition either with history of recurrent chest infection or aspiration. We present a case where patient present with weight loss and chronic dysphagia few months following ingestion of small denture. Keywords: Tracheo-oesophageal fistula, dysphagia, foreign body, oesophagus, dentures., Table of Contents Abstract Case report Discussion Conclusion References Case report A 40 year old gentleman attended our department with history of progressive dysphagia for 9 months. As he was [...]

Congenital intrathoracic H-type isolated tracheo-oesophageal fistula is a rare malformation that presents with a characteristic triad of symptoms: choking and cyanosis on feeding, recurrent lower respiratory tract infection and abdominal distension. Children are invariably symptomatic from birth, although the symptoms may be intermittent and may vary in severity. A high index of suspicion is required because the symptoms are not specific. Establishing the diagnosis can be difficult and neither radiology nor bronchoscopy is infallible. Surgical division of the fistula is curative. We report two cases of intrathoracic H-type fistula which are very rare. Keywords: Tracheo-oesophageal Fistula (TOF), H-Type, Table of Contents Abstract Introduction Case Report Case 2 Discussion Conclusion References Introduction Late presentations of tracheo-oesophageal fstulae (TOF) in childhood are uncommon. Congenital tracheo-oesophageal H-type fistulae without any associated [...]

(CHEST 2001; 119:955-957) A 52-year-old woman was referred to the hospital for management of recurrent hemoptysis. She also reported an episode of hematemesis, which was initially thought to be unrelated [...]

To the Editor: We have read with interest the excellent letter of Dr. Rampaul and colleagues (CHEST; July 1999)[1] regarding the 'breathing bag' sign in the early diagnosis of tracheoesophageal [...]

Introduction: Congenital tracheoesophageal fistula (TEF) in adults is a rare disease. We describe a case of 68-year-old male with congenital TEF who had long standing symptoms mimicking nocturnal asthma. Patient [...]

Diagnosis of an abnormal opening between the trachea and esophagus may not be obvious in newborns if the esophagus has a normal outlet, and diagnosis may not occur until well into childhood. A 10-year-old girl sought medical treatment for abdominal bloating which she had experienced since infancy. An x-ray showed distention of the small and large intestine caused by gas. The initial diagnosis was of asthma, allergies, and swallowing air. A more detailed medical history revealed two cousins with a lack of esophageal outlets and one with an abnormal opening between the trachea and esophagus. Visualization of the trachea using bronchoscopy showed an abnormal opening to the esophagus just below the larynx, which was surgically closed. Her abdominal bloating went away, but the asthma remained.

We report a case of Boerhaave's syndrome complicated by a large bronchopleural fistula due to autolysis of lung parenchyma by gastric contents, a complication not previously documented to our knowledge. [...]