Congenital bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia

Abstract

A case of initial esophageal atresia and tracheoesophageal fistula in a female newborn, later complicated by pneumonia and a second bronchoesophageal fistula, is reported. She was treated surgically by closure of the tracheoesophageal fistula and by end-to-end esophago-esophageal anastomosis. An esophagram at 1 month of age was normal. Three months later she developed severe, persistent right lower lobe pneumonia that required intensive antibiotic therapy and respiratory support. Esophagography was repeated and revealed a second fistula between the right main-stem bronchus and the lower esophagus. The bronchoesophageal fistula was repaired, and a right lower lobectomy was performed. Postoperative recovery was uncomplicated. Histologic examination indicated that the fistula was congenital in origin. To the best of our knowledge, this is the first reported case of a congenital bronchoesophageal fistula coexisting with a tracheoesophageal fistula and esophageal atresia.

Congenital bronchoesophageal fistula repaired by bronchoscopy‐assisted fistulectomy in a neonate

“…Braimbridge and Keith [3] classified congenital BEF into four types. Type II BEF is most common in adults, but rare in neonates [2]. Here, we report a neonate who presented with type II BEF, which was difficult to diagnose prior to surgery.…”

“…Thirdly, an esophageal fold or membrane flap may create a check valve to mask the fistula. In other words, MDCT cannot definitely detect the disease because of tiny lesions or the respiratory motion artifacts, especially in neonates [2].…”

“…The presentation of BEF is nonspecific, including chronic pneumonia, coughing, and hemoptysis [2]. This case was a neonate with isolated BEF presenting with several pulmonary complications.…”

Thoracoscopic pneumonectomy for communicating bronchopulmonary foregut malformation in a 4-month-old child

“…One study identified 105 cases of bronchopulmonary fistula, with only 20 diagnosed in children younger than 15 years [2]. Another study looked at 100 cases, with 24 in the pediatric population [3]. The reasons for delayed diagnosis are poorly understood but are likely due to vague presentation in many patients.…”

An unusual cause of haemoptysis in childhood: A case report and literature review

“…This is definitively diagnosed only on histological examination by the absence of surrounding inflammation, the absence of adherent lymph nodes and the presence of a mucosa and muscularis mucosa. [5,6] The most common location of BOFs is between the middle third of the oesophagus and the right lower lobe (41%), followed by the left lower lobe (21%), right main bronchus (18%), bronchus intermedius (10%), left main bronchus (6%), right middle lobe (2%) and right upper lobe (2%). [3,5] Symptoms of BOFs are insidious, occasionally beginning in childhood but rarely at birth.…”