Intermittent gaseous bowel distention: Atypical sign of congenital tracheoesophageal fistula

Gardella, Chiara; Tomà, Paolo; Sacco, Oliviero; Girosi, Donata; Panigada, Serena; Battistini, Elena; Mattioli, Girolamo; Jasonni, Vincenzo; Rossi, Giovanni

doi:10.1002/ppul.20987

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…The coughing, choking and cyanosis during feeding is considered the classical "three Cs" of H-type fistulas by some authors (14,15). During feeding, esophageal content tends to move into the trachea under the pressure gradient generated by esophageal contractions (16). Liquids cause greater difficulty than solids.…”

Section: Signs and Symptomsmentioning

confidence: 99%

Management of congenital isolated H-type tracheoesophageal fistula

Durakbaşa¹

2022

Curr Chall Thorac Surg

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Congenital H-type tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is also called isolated TEF or N-type TEF. The fistula is oblique extending from a cephalad opening on the posterior wall of the trachea to a more caudal position on the anterior esophageal wall. H-type TEF is a rare anomaly comprising about 4% of all EA spectrum of anomalies. Characteristically, the fistula is located at a more cephalad level of the trachea than in TEF associated with EA cases. It is near or above the thoracic outlet in many cases. Coughing, choking and cyanosis during feeding are typical neonatal manifestations of the anomaly and are called the "three-Cs". A high index of suspicion is the key for an early diagnosis. It may be delayed in some cases although they almost always have suggestive pulmonary manifestations. The most commonly employed diagnostic tools are esophageal contrast studies and bronchoscopic evaluation. Contrast studies are preferably performed as a tube esophagogram with pullback technique. Bronchoscopy has a higher diagnostic accuracy and also enables catheterization of the fistula before a surgical intervention. The treatment is surgical. Surgery is usually performed by a lateral cervical approach especially if the level of the fistula is at or above the T2 vertebra level. More caudal fistulas are usually approached either by thoracotomy or thoracoscopy. The most common postoperative complications encountered are recurrent laryngeal nerve injury with resultant vocal cord dysfunction and fistula recurrence. The latter should be repaired by repeat surgery. Vocal cord dysfunction may be temporary and a conservative approach can be undertaken.

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Section: Signs and Symptomsmentioning

confidence: 99%

Management of congenital isolated H-type tracheoesophageal fistula

Durakbaşa¹

2022

Curr Chall Thorac Surg

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“…It is sporadically reported in the current literature in small series (8). Almost all patients are diagnosed within the first three years of life, most of the cases being recognized before the age of 12 months, respectively in the neonatal period (4,9), while H-type TOF is rarely diagnosed beyond childhood and even more limited in adult surgical experience (10,11).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical key points for H-TOF diagnosis are classical and they are represented by coughing or paroxysmal choking during feeding, pneumopathy or history of pneumopathy, repeated cyanosis and, infrequently, abdominal distension (4,5), which are often intermittent and they are related to fistula size, co-existence of respiratory effort or endotracheal intubation anesthesia (3,9).…”

Section: Discussionmentioning

confidence: 99%

“…Radiological studies in the premise of H-TOF should be made with particular vigilance in sites with quick access to intensive care units and professionals prepared for prompt resuscitation and, preferably, by experienced radiologists. Isotonic water-soluble contrast agents are recommended (5,9,13). In our experience, barium swallow has been used to obtain conclusive images of H-TOF and the preparation of a low viscosity solution (dilution) plays a significant role in obtaining adequate images of the tracheoesophageal passage.…”

Section: Discussionmentioning

confidence: 99%

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Practical safety in the diagnosis and treatment of congenital isolated tracheoesophageal fistula

et al. 2021

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The rareness of H-type tracheoesophageal fistula in conjunction with its unspecific clinical presentation and wide range of anatomical presentation makes its diagnosis and treatment a problematic topic for both ear, nose and throat (ENT) specialists and pediatric surgeons worldwide. Symptoms and clinical signs of H-TOF are easily misleading. Diagnostic methods, most of the times, are dependent on the physician's experience; therefore, various errors may be made. We analyzed our experience in managing H-TOF cases over the last 15 years. Advice and strategies of action for health professionals directly involved in the diagnosis and treatment were identified, but also errors and mistakes while managing 6 cases. We analyzed 'red flags' but also important steps in the practical safety concerning this rare congenital malformation. Choosing the surgical access for division of the fistula throughout the cervical or thoracic approach is sometimes difficult. A scrupulous perioperative planning is mandatory. A dynamic overview of the patient's presentation never underestimating the subtlety of H-TOF presentation should be conducted for its early recognition and achieving best outcomes.

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“…This section briefly describes the compressions and dislocations of the tracheobronchial tree produced by anomalous anatomical relations, as in the case of the double aortic arch [54] or dilatation of the heart or pulmonary vessels in a setting of congenital heart defects. These cases can now be studied by MDCT and/or MR imaging.…”

Section: Anomalie Vascolarimentioning

confidence: 99%

Multislice CT in congenital bronchopulmonary malformations in children

et al. 2010

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Congenital bronchopulmonary malformations encompass a wide spectrum of pathologies involving the lungs, trachea and bronchi, pulmonary vessels, and oesophagus. These developmental lesions are often isolated, but the association of two or more anomalies is not infrequent. Contrast-enhanced multidetector computed tomography (MDCT), thanks to multiplanar and 3D reconstructions, allows for detailed studies of these malformations, achieving better accuracy compared with conventional techniques such as chest X-ray, fluoroscopy, ventilation and perfusion scintigraphy and ultrasonography. MDCT is characterised by fast data acquisition and does not require sedation in the majority of cases. The main drawbacks of MDCT are the use of ionising radiation and - in many cases -contrast media. Recently, improved CT scanners and optimised CT protocols have made available to children all the benefits of MDCT, thanks to a significant reduction in radiation dose and an improved risk-benefit ratio. The aim of our paper was to evaluate MDCT in children with bronchopulmonary malformations by reporting our experience (about 2,400 studies in 30 months with a 64-slice MDCT scanner) and comparing it with the available literature.

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Intermittent gaseous bowel distention: Atypical sign of congenital tracheoesophageal fistula

Cited by 6 publications

References 7 publications

Management of congenital isolated H-type tracheoesophageal fistula

Management of congenital isolated H-type tracheoesophageal fistula

Practical safety in the diagnosis and treatment of congenital isolated tracheoesophageal fistula

Multislice CT in congenital bronchopulmonary malformations in children

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