Updated: 12/25/2021

Transesophageal Fistula

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  • Snapshot
    • A newborn child is brought to the emergency room with excessive drooling, as well as coughing and choking during feeding. The physician notes cyanosis that is unrelieved by crying. Bilateral pulmonary rales are appreciated on exam. There is also abdominal distension with tympany on percusion.
  • Introduction
    • Congenital anomaly resulting in a tract between the trachea and esophagus
  • Epidemiology
    • Occurs in roughly 1:4000 births
  • ETIOLOGY
    • Associated with esophageal atresia and other VACTERL anomalies including
      • vertebral
      • anal
      • cardiac
      • tracheal
      • esophageal
      • renal
      • limb defects
  • Presentation
    • Symptoms
      • increased oral secretions
      • feeding difficulty
      • gagging/choking
      • hyperventilation or other respiratory dysfunction
    • Physical exam
      • respiratory distress
      • polyhydramnios in utero
      • rales on pulmonary ausculation
      • cyanosis
      • abdominal distention
        • caused by swallowing air during feeding
  • IMAGING
    • CXR
      • may show NG tube coiled in esophagus
    • KUB
      • may identify air in the GI tract
    • Bronchoscopy
      • confirms anatomic abnormality (i.e. narrowing of esophagus and/or fistula)
    • Prenatal Ultrasound
      • may show polyhydramnios
  • Differential
    • Esophageal atresia
  • Treatment
    • Prevention
      • no preventive measures are available at this time
    • Surgical intervention
      • surgical repair
        • considered a surgical emergency when identified
        • prevents further lung damage
  • Complications
    • Aspiration pneumonia
    • Choking
    • Esophageal stricture post-operatively
    • Reflux post-operatively
  • Prognosis
    • Good outcome with early prognosis and treatment

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(M2.PD.15.19) A 1-day-old male infant is transferred to the NICU for significant coughing, choking, and reflux from the mouth and nose shortly after his first feeding. During this episode, the neonate developed respiratory distress and became transiently cyanotic. The patient is a first-born male, and the mother's pregnancy and delivery was without complication. In the ICU, a nasogastric (NG) tube is placed, returning a small amount of mucus and secretions. A chest radiograph is performed and shown in Figure A. Which of the following is the most likely diagnosis in this patient?

QID: 105417
FIGURES:

Laryngeal cleft

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Normal spit-up

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Gastroesophageal reflux disease

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Esophageal atresia and tracheoesophageal fistula

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Pyloric stenosis

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M 6 E

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