Congenital tracheo-oesophageal fistula in the adult

Thoracoscopic Repair of Adult-Onset Congenital Tracheoesophageal Fistula Using a Polyglycolic Acid Sheet-Buttressed Stapler

Congenital tracheoesophageal fistula (TEF) without esophageal atresia is usually diagnosed and treated in the neonatal period. It is uncommon to occur in adulthood. Conventional treatment of adult-onset TEF involves repair by either cervicotomy or thoracotomy. We reported the case of a 31-year-old male patient with clinical and radiographic evidence of congenital H-type TEF. Although this fistula was located at the level of the second thoracic vertebra, the repair of the anomaly was performed successfully using a thoracoscopic approach with the novel use of a polyglycolic acid sheet reinforcement.

Surgery Complicated by Self-Expandable Metallic Stents (SEMS) Tracheal Stent in a Congenital H-type Tracheo-Esophageal Fistula

A congenital tracheo-esophageal fistula of the H-type is a rare variant. The diagnosis is usually missed because of mild symptoms. A long history of coughing during liquid intake and nocturnal cough may aid in the diagnosis. A delay in the diagnosis may have a deleterious effect on the lung because of recurrent infections. Surgery is the cornerstone of management. Self-expandable metallic stents (SEMS) do not have a role in the management of these fistulae. We report a case of a missed diagnosis of a congenital H-type fistula managed as an acquired tracheo-esophageal fistula with two attempts at conservative management with a tracheal self-expandable metallic stent. The difficulties and disadvantages of using self-expandable metallic stents for the management of benign tracheo-esophageal fistulae are also discussed.

Presentation of an H-type tracheoesophageal fistula in an adolescent male with cystic fibrosis: A case report and review of literature

Congenital TEFs without esophageal atresia are rare but may occur more frequently than previously documented in literature. Careful history is required to suspect the diagnoses, as most patients will present with coughing associated with solid or liquids, recurrent unexplained pulmonary infections and complaints with eating. Some patients may show signs of chronic airway changes from recurrent aspiration pneumonia at the time of presentation. Diagnosis is challenging, with multiple imaging modalities including x ray, CT scan and esophogram able to identify a fistula. Surgery is required to improve quality of life and prevent chronic airway changes, and most cases repaired have no complications.

Congenital H-type tracheoesophageal fistula in adults

Congenital tracheoesophageal fistulas (TEFs) in the adults are uncommonly reported but they are serious conditions that can cause severe morbidities and mortality. Three cases were identified in the last 16 years. The diagnosis was not easy but they were all successfully surgically repaired with good results. A detailed history and meticulous examination of the radiological studies will help diagnose this condition. Surgical repair should be performed once diagnosed.

A case of surgery for congenital esophagobronchial fistula accompanied by a destroyed lung

Congenital esophagobronchial fistula (EBF) is rarely seen in adults. We report a case of EBF detected in adulthood with a destroyed lung. A 67-year-old man experienced repeated pneumonia during his childhood. Since the age of 38, he had often suffered from bloody phlegm and always had a cough and sputum during oral intake. Before cardiac surgery for atrial fibrillation and valvular disease, computed tomography (CT) detected bronchiectasis, which could cause pulmonary bleeding during heart surgery, and the patient was introduced to our hospital for lung resection. A fistula between the esophagus and the right lower lung lobe was found using CT, esophagoscopy, and esophagography. Contrast CT and angiography revealed an abnormal artery branching from the inferior phrenic artery into the lobe. As indicated by intraoperative findings, the middle and lower lobes had strongly adhered to chest wall and diaphragm, but we located the fistula easily without adhesion to the surroundings, severed it using an automatic stapler, and resected the middle and lower lobes. The symptoms disappeared immediately, and the patient was uneventfully discharged.

The diagnosis of congenital EBF was established with intraoperative findings and pathological exam. The existence of pulmonary sequestration was suggested because of the long-term absence of any symptoms during his adulthood, the tract of the EBF running into the lung, not directly into the bronchus, and a septum pathologically detected in the right lower lobe. A congenital EBF should be considered for differential diagnosis in cases of limited bronchiectasis in elderly people.

Congenital tracheoesophageal fistula: A rare and late presentation in adult patient

Congenital H-type tracheoesophageal fistula (TEF) in adults is a rare presentation and can test the diagnostic acumen of a surgeon, endoscopist, and the radiologist. These undetected fistulas may present as chronic lung disease of unknown origin because repeated aspirations can lead to recurrent lung infections and bronchiectasis. Congenital TEFs should be considered in the diagnosis of infants and young adults with recurrent respiratory distress and/or infections. Here, we present the successful management of this rare case in an adult patient.

Reversible airway obstruction caused by changing the size and length of an endotracheal tube in a premature neonate with suspected tracheomalacia -A case report-

Tracheomalacia is a malformation of the tracheal membranosa. It is maintained during spontaneous breathing but can be altered by bronchoscopy or positive airway pressure. Tracheomalacia is associated with a high mortality and may cause prolonged intubation and ventilation. Here, the case of a 13-day-old infant with jejunoileal stenosis that had surgery is reported. During induction of general anesthesia, endotracheal intubation was attempted several times with different sized endotracheal tubes. Airway obstruction occurred after the endotracheal intubation. After the airway was maintained, the operation was completed. Tracheomalacia was diagnosed after otolaryngology evaluation postoperatively.

Late presentation of congenital tracheo-oesophageal fistula

Congenital tracheo-oesophageal fistula presenting in adulthood is extremely rare. Such a case is presented in a patient who suffered repeated chest problems as an infant, which persisted through the years, and was ultimately diagnosed as 'bakers lung' due to his occupation. He was referred with persistent cough to the ENT department, and an upper endoscopy located a tracheo-oesophageal fistula, which was subsequently resected with complete resolution of his symptoms. Unresolving chest problems or persisting cough should alert the doctor to such a possible diagnosis.

Congenital broncho-oesophageal fistula in the adult

Five patients with congenital broncho-oesophageal fistula confirmed by fistulectomy are presented. Clinical symptoms were chronic or recurrent pulmonary infection, and three patients experienced coughing after swallowing. Pre-operative oesophagograms demonstrated broncho-oesophageal fistulas in all five patients. The fistulous communications were from the lower oesophagus to segmental bronchi of the lower lobe and to the left main bronchus. The fistulas showed smooth marginated serpentine margins with areas of internal trabeculation, and in two patients the fistulas communicated with anomalous bronchi. One patient had anomalous bronchi and subsequently underwent lobectomy which showed microscopic findings of intralobar sequestration. The oesophagus showed localized tenting with its apex to the fistula and mild ipsilateral displacement in four patients.

Congenital tracheoesophageal fistula associated with carcinoma of the lung in an adult

A rare case of adult congenital H-type tracheoesophageal fistula was diagnosed. Subsequently, at operation, large cell, undifferentiated carcinoma of the right middle lobe with extension to the right lobe and adherence to the diaphragm was documented. The diagnosis, surgical intervention, and 4-year follow-up are presented.

Difficulties in diagnosis of congenital H-type tracheo-oesophageal fistulae

The case notes of 12 children with congenital H-type tracheo-oesophageal fistulae diagnosed at the Hospital for Sick Children, Great Ormond Street, who presented between 1980 and 1986 were reviewed. All patients presented early in the neonatal period with recurrent chest infections; abnormal chest radiographs were found in eight. Ten of a total of 19 contrast studies were negative. Tube oesophagograms were more likely to demonstrate a fistula than conventional contrast studies. Any delay in surgery was due to delay in diagnosis rather than to delay in presentation. The results suggest that tube oesophagograms should be performed early where there is clinical suspicion of an H-type fistula, and that other investigations (for example bronchoscopy) should be considered if the tube oesophagogram does not demonstrate a fistula.

Congenital bronchoesophageal fistula in the adult

Congenital bronchoesophageal fistulas usually present in infants and may occur with or without esophageal atresia. Twenty cases of congenital bronchoesophageal fistula in adults have been reported in the English literature. Another case of this rare developmental anomaly is presented here. The radiographic, endoscopic, surgical, and pathologic findings are discussed with a review of the literature.