H type tracheo-oesophageal fistula: 2 cases with review of literature
Keywords:H fistula, Rare, Difficult to diagnose
Tracheo-oesophageal fistula (TEF) with oesophageal atresia is a common life threatening congenital malformation. H type TEF is a rare subtype (1.8 to 4.2% of all TEF) with the least association with congenital anomalies. We report two cases of H type TEF, first patient was a 2 month old girl who presented with the classical triad of symptoms, and the second patient was a 2 year old girl who presented with recurrent attacks of pneumonia, choking on feeding and noisy breathing. After radiological confirmation, optimization of pulmonary status and nutritional improvement, both underwent right cervicotomy with disconnection of the H fistula. Both patients are doing well on regular follow up. Detection of H fistula is difficult as compared to TEF since the clinical symptoms are variable, radiological detection difficult and diagnosis is based on a high degree of clinical suspicion. We present these two cases to document the history, presentation, clinical management and surgical procedure done in these patients.
Spitz L. Esophageal atresia and tracheoesophageal malformations. In: Ashcraft KW, Holcomb GW, Murphy JP, editors. Pediatrics Surgery. Saunders: Philadelphia, PA, USA. 2005;352-70.
Tarcan A, Gurakan B, Arda S, Boybat F. Congenital H type fistula: delayed diagnosis in a preterm infant. J Matern Fetal Neonatal Med. 2003;13:279-81.
Riazulhaq M, Elhassan E. Early recognition of H-Type tracheoesophageal fistula. APSP J Case Rep. 2012;3(1):4.
Waterston DJ, Carter REB, Aberdeen E. Esophageal atresia: tracheoesophageal fistula. Lancet. 1962;1:819.
Holder T, Cloud DT, Lewis JE, Pilling GP. Esophageal atresia and tracheoesophageal fistula. Pediatrics. 1964;34:542.
Killen D, Greenlee HB. Transcervical repair of H type congenital tracheoesophageal fistula. Ann Surg. 1965;162:67-9.
Crabbe DCG. Isolated tracheoesophageal fistula. Paediatr Respir Rav. 2003;1:74-8.
Le SD, Lam WW, Tam PK, Cheng W, Chan FL. H-type tracheo-oesophageal fistula: appearance on three-dimensional computed tomography and virtual bronchoscopy. Pediatr Surg Int. 2001;17(8):642-3.
Gunlemez A, Anik Y, Elemn L, Tugay M, Gokalp AS. H type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on MRI. J Perinatol. 2009;29(5):393-5.