Online Exclusives
Double H-type tracheoesophageal fistulas identified and repaired in 1 operation
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.Transillumination of H-type tracheoesophageal fistula using flexible miniature bronchoscopy: an innovative technique for operative localization
Precise localization of the fistula is the most important step in the operative strategy for dealing with H-type tracheoesophageal fistula. Bronchoscopic cannulation of the fistula with a Fogarty or ureteric catheter has been recommended to aid ready identification, but it is not always successful. We report an innovative technique that permitted localization of H-type fistula intraoperatively. A flexible pediatric 2.2-mm bronchoscope (Olympus BF Type N20) was steered through a standard endotracheal tube, and the fistula tract was illuminated, making its identification and subsequent repair straightforward.
