The diagnosis and treatment of H-type tracheoesophageal fistula

Background: H-type tracheoesophageal fistula (TEF) was diagnosed in 12 patients during the 25 years from 1971 to 1996. Although all patients were symptomatic since birth, in 58% of the cases, there was a diagnostic delay ranging from 26 days to 4 years. Methods: Esophagography and/or cineesophagogra...

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Bibliographic Details
Published in:Journal of pediatric surgery 1997-12, Vol.32 (12), p.1670-1674
Main Authors: Karnak, İbrahim, Şenocak, Mehmet Emin, Hiçsönmez, Akgün, Büyükpamukçu, Nebil
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bronchoscopy
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Medical sciences
Pneumology
Respiratory system : syndromes and miscellaneous diseases
Retrospective Studies
Tracheoesophageal Fistula - diagnosis
Tracheoesophageal Fistula - surgery
Treatment Outcome
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Summary:Background: H-type tracheoesophageal fistula (TEF) was diagnosed in 12 patients during the 25 years from 1971 to 1996. Although all patients were symptomatic since birth, in 58% of the cases, there was a diagnostic delay ranging from 26 days to 4 years. Methods: Esophagography and/or cineesophagography, or bronchoscopy and simultaneous methylene blue administration confirmed the diagnosis of H-type TEF. Although cineesophagography is highly effective in demonstrating H-type TEF today, bronchoscopy must be used in every patient suspected of having fistula, especially when the radiological methods fail. Bronchoscopy is helpful in diagnosis, in evaluation of associated respiratory tract anomalies, and in treatment. Results: Two newborn patients could not have been operated on because of pulmonary insufficiency resulting from delayed recognition of fistula. Ten patients underwent fistula repair, nine through cervical approach, and one through thoracotomy, with seven survivors. Conclusions: The results suggest that early diagnosis is essential in the newborn period. Oversight in identification of H-type TEF, unsatisfactory radiological method, masquerading symptoms related to associated anomalies, and minute symptoms in some patients may cause delay in diagnosis. Radiological and endoscopic procedures are complementary in both diagnosis and treatment of H-type TEF.
ISSN:0022-3468
1531-5037
DOI:10.1016/S0022-3468(97)90503-0