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Double H-type tracheoesophageal fistulas identified and repaired in 1 operation

      Abstract

      Isolated tracheoesophageal (“H-type”) fistula is a relatively uncommon congenital anomaly that can be difficult to identify and, at times, challenging to repair. We present a very unusual case of an infant with 2 distinct H-type tracheoesophageal fistulas (TEFs) identified and repaired in 1 operation.
      A newborn male infant presented with coughing with feeds. Contrast esophagram demonstrated an intrathoracic H-type fistula without esophageal atresia. In the operating room, rigid bronchoscopy was performed, and a second TEF was identified in the cervical region. A separate balloon catheter was placed in each fistula. The intrathoracic fistula was repaired through a thoracotomy incision, and the more proximal fistula was repaired through a cervical incision. Each repair was uncomplicated, and recovery was uneventful.
      Double H-type tracheoesophageal appears to be extremely rare. This case underscores the importance of searching for a second fistula by bronchoscopy before undertaking definitive repair of a TEF.

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      References

        • Spitz L.
        Oesophageal atresia.
        Orphanet J Rare Dis. 2007; 2: 24-37
        • De Jong E.M.
        • Felix J.F.
        • de Klein A.
        • et al.
        Etiology of esophageal atresia and tracheoesophageal fistula: “mind the gap”.
        Curr Gastroenterol Rep. 2010; 12: 215-222
        • El-Gohary Y.
        • Gittes G.K.
        • Tovar J.A.
        Congenital anomalies of the esophagus.
        Semin Pediatr Surg. 2010; 19: 186-193
        • Ng J.
        • Antao B.
        • Bartram J.
        • et al.
        Diagnostic difficulties in the management of H-type tracheoesophageal fistula.
        Acta Radiol. 2006; 47: 801-805
        • Schulte T.
        • Ankermann T.
        • Claas A.
        • et al.
        An extremely rare abnormality of a double tracheoesophageal fistula without atresia of the esophagus; a case report and review of the literature.
        J Pediatr Surg. 2009; 44: e9-e12
        • Babbitt D.P.
        Double tracheoesophageal fistula without atresia.
        NEJM. 1957; 257: 713-714
        • Garcia N.M.
        • Thompson J.W.
        • Shaul D.B.
        Definitive localization of isolated tracheoesophageal fistula using bronchoscopy and esophagoscopy for guide wire placement.
        J Pediatr Surg. 1998; 33: 1645-1647
        • Crabbe D.C.
        Isolated tracheo-oesophageal fistula.
        Paediatr Respir Rev. 2003; 4: 74-78
        • Hajjar W.M.
        • Iftikhar A.
        • Al Nassar S.A.
        • et al.
        Congenital tracheoesophageal fistula: a rare and late presentation in adult patient.
        Ann Thorac Med. 2012; 7: 48-50
        • Benjamin B.
        • Pham T.
        Diagnosis of H-type tracheoesophageal fistula.
        J Pediatr Surg. 1991; 26: 667-671
        • Brookes J.T.
        • Smith M.C.
        • Smith R.J.
        • et al.
        H-type congenital tracheoesophageal fistula: University Of Iowa experience 1985 to 2005.
        Ann Otol Rhinol Laryngol. 2007; 116: 363-368
        • Allal H.
        • Montes-Tapia F.
        • Andina G.
        • et al.
        Thoracoscopic repair of H-type tracheoesophageal fistula in the newborn: a technical case report.
        J Pediatr Surg. 2004; 39: 1568-1570
        • Rothenberg S.S.
        Experience with thoracoscopic tracheal surgery in infants and children.
        J Laparoendosc Adv Surg Tech A. 2009; 19: 671-674
        • Rothenberg S.S.
        Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula in neonates: evolution of a technique.
        J Laparoendosc Adv Surg Tech A. 2012; 22: 195-199
        • Ko B.A.
        • Frederic R.
        • DiTirro P.A.
        • et al.
        Simplified access for division of the low cervical/high thoracic H-type tracheoesophageal fistula.
        J Pediatr Surg. 2000; 35: 1621-1622
        • Kane T.D.
        • Atri P.
        • Potoka D.A.
        Triple fistula: management of a double tracheoesophageal fistula with a third H-type proximal fistula.
        J Pediatr Surg. 2007; 42: E1-E3