Diagnosis and surgical treatment of “H‐Type” tracheoesophageal fistulas

Abstract

Four cases of H-type tracheoesophageal fistula are reported. The patients all had chronic aspiration from the esophagus. Although serious symptoms were present in all, definitive diagnoses were not made until the patients had reached 1, 6, 12, and 50 years of age, because ordinary radiologic methods failed to establish the diagnosis. The angulation of the fistula usually prevents contrast medium in the esophagus from entering the trachea, especially with the subject upright. On the other hand, air easily passes from the trachea to the esophagus, eventually producing megaesophagus which may be confused with the picture of achalasia. An ill-advised Heller esophagomyotomy was done on 1 patient. All 4 patients eventually had successful closure of the fistulas. Three operations were by the transthoracic route, and 1 high fistula in an infant was closed through a cervical approach.

Achalasia-like findings in a case with delayed diagnosis of H-type tracheoesophageal fistula

“…Interestingly, all these patients were older than usual ages of children with this anomaly. All had distended esophagus on chest X-ray and upper GI series [3,7,14]. Detailed information about the anatomy of the esophagocardial junction could not be derived from the reports.…”

H‐type tracheoesophageal fistula masquerading as achalasia cardia in a 13‐year‐old child

“…Subsequent bronchoscopy and tube oesophagograms also failed to demonstrate the fistula. This can be a problem in the diagnosis of H‐type fistula owing to the angulations of the fistula preventing contrast entering the trachea 2 . The fistula should be divided and oversewn to prevent recurrence.…”

“…This diagnosis was not confirmed by oesophageal manometry and it is difficult to know whether this was a true achalasia cardia. The dilated oesophagus may have been a result of air passage from the trachea via the fistula producing a mega‐oesophagus 2 . Manometric studies in children are not routinely recommended for achalasia, 8 but it is paramount to confirm the diagnosis before proceeding to a Heller's myotomy.…”

“…Although the patients are symptomatic from birth; the diagnosis is often delayed owing to the rarity of this condition and overlap of symptoms associated with more common medical conditions. Diagnostic delays of up to 50 years have been reported in some series 2 . We report an unusual case of an incidental finding of H‐type tracheoesophageal fistula in a child during investigation for achalasia cardia.…”

Unilateral Bronchiectasis and Esophageal Dysmotility in Congenital Adult Tracheoesophageal Fistula.

“…The tracheal opening is usually above the esophageal opening, giving the fistula the appearance of a slanted "H" (7). Most of the cases have been reported in patients in their thirties with no predilection toward either gender.…”