Congential H-type tracheo-oesophageal fistula.

Abstract

Case reports Case 1. A girl who had been investigated in two hospitals for recurrent attacks of chest infection and episodes of abdominal distension dating back to birth. Barium swallow examinations at 10 and 15 months were reported as normal. Finally, an oesophagogram, with the dye injected through a catheter placed in the oesophagus, showed tracheal spill through a fistula at the level of the second and third dorsal vertebrae. She was operated on when 21 years of age through a left supraclavicular approach. Uneventful recovery followed.Case 2. A 7-day-old female infant was admitted with a history of being 'mucousy' since birth. This was associated with abdominal distension. The child became cyanosed after admission and chest x-ray examination showed right upper zone pneumonitis.Barium swallow examination 8 days later did not show anything abnormal, but a repeat examination outlined a fistula. The fistula was divided through a left supraclavicular approach. The infant died 10 hours after the operation. Post-mortem examination showed extensive bronchopneumonia.Case 3. A female newborn infant was admitted with a history of respiratory distress, abdominal distension, and vomiting. The child developed right-sided pneumonitis within the first 7 days. Barium enema and Received 26 February 1975. meal examinations were normal apart from revealing uncomplicated malrotation. Gastrografin swallow examination at one month of age showed evidence of a vascular ring. At 37 days of age an aberrant right subclavian artery was divided through a left thoracotomy. The child failed to improve after this and weighed only 6* 12 kg when 10 months old. A repeat oesophagogram then revealed a fistula. Division of this through a left cervical approach was followed by uneventful recovery.Case 4. A female infant was admitted when 2 months old with a history that she became distressed after every feed with vomiting, cyanosis, and dyspnoea and also had episodes of abdominal distension. Chest x-rays showed patchy pneumonitis on the right side. An oesophagogram showed an H-fistula at the level of the first thoracic vertebra. The child was operated upon at 10 weeks of age through a left cervical approach and made an uneventful recovery.Case 5. A male infant was detained in a neonatal unit for 5 weeks after birth because of a chest infection, and was readmitted when 3 months old for a recurrence of the same complaint. When he was admitted to our hospital at 9 months of age for a chest infection an oesophagogram showed an H-type fistula. This was divided through a left supraclavicular approach. Postoperative recovery was uneventful.

Early Dıagnosed Patıent Wıth Isolated Tracheoesophageal Fıstula

“…Oral beslenme sırasında solunum sıkıntısı, boğulma atakları, öksürük ve morarma olması izole TÖF olasılığını düşündürmelidir (1,3,7) . Hasta NGT ile beslenildiğinde bu bulguların ortadan kalkması fistül şüp-hesini kuvvetle desteklemektedir (7,8) .…”

“…İlk orjinal tanımlaması 1873 yılında Lamb tarafından yapılan (1) izole trakeoözofageal fistülün (TÖF) ilk cerrahi onarımı Imperatori tarafından 1939'da yapıl-mıştır (2) .…”

“…TÖF'lerin %98'i özofagus atrezisi ile birlikte görüldüğü için postnatal erken dönemde tanı konulabilmektedir (6) . Ancak izole TÖF'lerin tanılanması genellikle geç sütçocukluğu dönemine doğru ve hatta nadiren eriş-kin dönemde olmaktadır (1,3,6) . İzole TÖF; beslenme sırasında veya sonrasında aspirasyon semptomları ile kendini belli eder.…”

Recurrent pneumonia-H type Tracheoesophageal fistula, diagnostic dilemma.

“…The clinical features are variable; common being the recurrent respiratory symptoms, aspira on during feeding with cyanosis, abdominal distension. These episodes are treated as recurrent pneumonia with intravenous an bio cs 3,4 . The symptoms are usually present since birth, but the diagnosis is o en delayed and requires high index of suspicion.…”

“…Diagnosis is made soon a er birth with apparent clinical features, nevertheless H-type TEF are not diagnosed early because esophagus is patent. The triad of choking and coughing precipitated by feeds, recurrent chest infec ons, and episodes of abdominal distension was described in fi ve cases from Lady's Hospital for Sick Children and St. Joseph's Hospital, Dublin, between 1971 and 19744 . In most of the cases infants are treated for respiratory infec ons.…”