Tracheoesophageal Fistula Diagnosis And Management

Tracheoesophageal fistula (TEF) is a congenital anomaly characterized by an abnormal connection between the trachea and the esophagus.

Often occurs in conjunction with esophageal atresia.
Associated with congenital heart disease (Patent foramen ovale, PDA, VSD)

Type A	7%	Esophageal atresia only, no connection between esophagus and trachea
Type B	2%	Proximal esophagus connect with trachea
Type C	86%	Distal esophagus connect with trachea
Type D	1%	Both proximal and distal end of esophagus connect with trachea separately
Type E	4%	Both proximal and distal end of esophagus connect with trachea and there is connection between both ends

Table of Contents

History and Examination

Risk factors: Maternal polyhydramnios, family history, chromosomal abnormalities, VACTERL association
Often detected in the prenatal period or shortly after birth

Symptoms	Signs
Excessive frothing from mouth Coughing and choking while attempting to swallow Cyanosis during feeding Respiratory distress	Frothy secretions and saliva in the mouth and nose Abdominal distension Inability to pass a nasogastric tube into the stomach

Differential diagnosis (D/D) & Complication

D/D:
• Choanal atresia (Unilateral or bilateral nasal obstruction, no feeding issues)
• Laryngeal cleft (Recurrent aspiration, no esophageal issues)
• Congenital diaphragmatic hernia (Respiratory distress, scaphoid abdomen)

Complications:
• Aspiration pneumonia due to reflux of gastric contents through the fistula.
• Malnutrition
• Respiratory complications
• Gastroesophageal reflux

Investigation

Prenatal ultrasound (for polyhydramnios)
X-ray Chest + Abdomen: Before doing x-ray, insert the NG tube. In TEF, there will be coiling of NG tube.

Admission Criteria

Infants with confirmed or suspected TEF require immediate admission for surgical evaluation and management

Management

Emergency management

Secure Airway, elevate head, do suctioning of secretion
IV line access and start fluid therapy

Medical– No medical management required.

Surgery

Indication: Confirmed diagnosis of TEF
Procedure: Primary repair of the TEF and esophageal atresia

After initial management refer patient to pediatric surgeon for surgical management.

References

Choudhury, S. R., & Ashcraft, K. W. (2016). Esophageal atresia and tracheoesophageal fistula. In Holcomb and Ashcraft’s Pediatric Surgery (6th ed., pp. 377-394). Elsevier.
Bairdain, S., & Hamilton, T. E. (2018). Surgical management of esophageal atresia and tracheoesophageal fistula. Seminars in Pediatric Surgery, 27(2), 92-98.
Rothenberg, S. S. (2012). The first decade’s experience with thoracoscopic repair of esophageal atresia in infants. Journal of Pediatric Surgery, 47(1), 217-221.