H-type tracheoesophageal fistula in neonatal period: Difficulties in diagnosis and different treatment approaches. A case series

Abstract

Congenital tracheoesophageal fistula not associated with esophageal atresia, known as H-type fistula, is an uncommon anomaly. It presents with cough, choking, and cyanosis during feeding and/or recurrent pneumonia. Although symptoms are usually present from birth, diagnosis is difficult. The rarity of this disease, non-specific symptoms, and the limitations of radiological and endoscopic confirmation of the fistula often result in a delay between presentation and diagnosis confirmation. Here we describe the clinical manifestations, assessment methods, and management of 3 newborn infants with H-type tracheoesophageal fistula, together with diagnosis recommendations to prevent unnecessary delays in the management of this condition.

Detection of Oesophageal Fistula by Radionuclide Salivagram SPECT/CT

“…Previous studies have shown that salivagram is often used in the diagnosis and treatment of congenital oesophageal atresia, tracheo-oesophageal fistula, and aspiration pneumonia in children (19)(20)(21)(22). From these reports, we can also infer that salivagram is a safer method of inspection.…”

Cases

“…To improve sensitivity, this test should be performed with a nasogastric tube in situ and the child should be in the prone position. [6] The nasogastric tube should be withdrawn slowly while injecting contrast. Contrast-enhanced studies carry a risk of aspiration pneumonia and should be performed with adequate emergency resuscitation tools at hand.…”

H-type congenital tracheo-oesophageal fistula associated with oesophageal stenosis: anatomical variant

“…Although some H-type variations of EA have been described previously [ 7 ], to our knowledge, the presence of an H-type congenital tracheo-oesophageal fistula associated with oesophageal stenosis in a neonate has yet to be reported in the literature. Thus, surgeons treating patients with suspected EA must be aware of this variant.…”