In this lecture, we’re going to
discuss tracheoesophageal fistula.
So TEF or tracheoesophageal fistula
is an abnormal congenital connection
between the trachea and the esophagus.
There are five types.
Type 1 is by far the most common.
This is an atresia with a fistula
between the distal esophagus
and the trachea as
is pictured here.
You can see the esophagus
The stomach is connected to trachea.
So these patients will
show up very, very early.
Their first meal, it ain’t going anywhere.
They’ll spit up.
A smaller percentage, 8%, have a
completely atretic stomach and esophagus.
In other words, there’s not fistula.
There’s simply a blind and looped
esophagus and a blind and looped stomach.
These infants should have no gas bubbles
in their intestines on an X-ray,
and will spit up very
quickly after eating.
This represents 8%.
You can see we’ve already accounted for
most of tracheoesophageal fistula.
Almost the rest are the third type
and this is an H type of fistula.
The H type fistula is
basically a connection
between the trachea
and the esophagus.
There’s a little bridge.
So these infants are interesting and that
they can present a little bit later on.
Basically, at some point, their gastric
contents do dribble into the lungs
and they get respiratory
distress often with eating.
So this is fistula
without any atresia
compared too the last one, which was
an atresia without any fistula.
There are two other very rare
types that you might hear about.
One is where the proximal
esophagus feeds into the trachea.
There is no path to the stomach.
The other is the same except
there is a path to the stomach,
the proximal esophagus
enters the trachea
and then the distal esophagus arises from
the trachea a little bit farther down.
When we see TEF, about half of patients
will have an associated anomaly.
An example might be CHARGE syndrome.
In CHARGE syndrome,
they may have coloboma as you can see
in this patient here with that black
pupil that’s extending down
in the patient’s left eye.
They may have heart defects or an
atresia such as choanal atresia.
Or they may have retardation or what we
like to call intellectual disability.
They may have genital malformations
or they may have ear anomalies.
CHARGE, C-H-A-R-G-E, and those
are symptoms they may have.
They may also have
Another defect more classically associated
with tracheoesophageal fistula is VACTERL.
Again, each of these letters count for
a symptom that these patients have.
V is vertebral defects.
A is anal atresia.
C is cardiac defects,
particularly a VSD and the TE stand
for tracheoesophageal fistula.
They also have renal
anomalies or malformations
and they have limb defects such as radial
dysplasia, polydactyly or syndactyly.
So most TEF presents almost
immediately after birth.
These patients have food that cannot
get into the stomach in most cases.
This results in immediate emesis and
rapid dehydration outside of the uterus.
Additionally, gastric contents may enter the
lungs resulting in respiratory distress.
So the diagnosis of TEF
is usually made because it’s impossible
to get the NG tube into the stomach.
These infants are sick.
We place an NG in and we can’t
get it into the stomach.
Instead it coils up in
the proximal esophagus.
So we put in the NG, we take an x-ray and,
wow, look at that NG,
it didn’t go in.
Maybe this child has a TEF.
Alternatively we can make a more
definitive diagnosis by doing endoscopy.
We scope, we look down
there, it’s a blind loop.
So the H type fistula
is the one I think that
comes to mind the most often
because it’s more subtle.
This is only four percent
of all cases of TEF.
But this one can present later on in life.
It’s basically a fistula that’s small.
So there can be a delay in diagnosis.
Patients present with coughing, wheezing,
and struggling with feeds and reflux.
As you can see in this picture,
the food goes down the esophagus
and then somehow gets into the
trachea and can cause problems.
Some of the food keeps going.
So that’s my summary
of TEF in children.
Thanks for your time.