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Triple fistula: management of a double tracheoesophageal fistula with a third H-type proximal fistula

  • Timothy D. Kane
    Correspondence
    Corresponding author. Tel.: +1 412 692 7282; fax: +1 412 692 8299.
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA
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  • Prashant Atri
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA
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  • Douglas A. Potoka
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA
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      Abstract

      Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a relatively common congenital condition in which there have been several described anatomical variants. The most common type, EA with distal TEF, comprises more than 75% of cases in many reports. Less commonly, a smaller proximal pouch fistula (H-type) will be associated with this most common variant in 1.4% of these cases. Only 2% of all cases of EA/TEF will have 2 large fistulas between the trachea and esophagus in which the end of the upper esophageal pouch connects terminally to the midtrachea and the distal esophagus arises from the trachea near the carina. Here we describe the management of an infant with this type of EA/TEF who was also found to have an H-type TEF of the proximal trachea. The combination of this type of EA/TEF with an associated H-type TEF or “triple fistula” has been previously described in the literature in only 1 other patient.

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