Tracheoesophageal fistula
Overview
Tracheoesophageal fistula (TEF) is commonly a birth defect, with the trachea connected to the esophagus. In most cases, the esophagus is discontinuous, causing immediate feeding difficulties. TEFs may develop in adult life, secondary to the invasion of cancer in the area. In addition, TEFs may be deliberately constructed with surgery to aid talking in a patient who has the larynx removed (a laryngectomy).
Symptoms
Small H type fistulas may go undiagnosed until later in life. Symptoms of an H type fistula include frequent pulmonary infections and bouts of abdominal bloating.
Causes
Tracheoesophageal fistulas arise as a developmental abnormality. At birth, the infant has difficulty swallowing. Eating produces severe coughing spells that interfere with breathing. Aspiration pneumonia can develop from fluid breathed into the lungs.
Prognosis
Infants who have tracheoesophageal fistula often have other birth defects that affect their recovery. Even when the esophagus is successfully separated and reattached, many infants have difficulty swallowing, because the contractility of the esophagus is impaired. Infants may also have problems with gastroesophageal reflux, in which the acidic contents of the stomach back up into the bottom of the esophagus and cause ulcers and scarring.
Treatment
Babies with all but H type fistulas are unlikely to survive without surgical separation and repair of the trachea and the esophagus. Surgery cannot always be performed immediately because of prematurity, the presence of other birth defects, or complications from aspiration pneumonia. It is usually done at a hospital that has special facilities for treating seriously ill newborns. While awaiting surgery, the infant's condition is stabilized. Preoperative care concentrates on avoiding aspiration pneumonia and includes: elevating the head to avoid reflux and aspiration of the stomach contents using a suction catheter to continuously removed mucus and saliva that could be inhaled when necessary, placement of a gastrostomy tube withholding feeding by mouth When surgery is performed, the esophagus is reconnected to make it continuous and separate from the trachea. If the two ends of the esophagus are too far apart to be reattached, a piece of tissue from the large intestine is used to join the parts.