Diagnosis and Management of Isolated Tracheoesophageal Fistula: A Case Report

Isolated tracheoesophageal fistula (TEF) or H-type TEF is a rare congenital malformation of the esophagus in which a fistula between the lower trachea and the membranous part of the esophagus may lead to choking precipitated by feeding. Because of its rareness, diagnosis and surgical management of this anomaly can be challenging. A 2-month-old male infant presented with frequent cough and occasional choking during breastfeeding, beginning from his 3 days of life. At 2 weeks of age, the infant developed tachypnea and fever and was diagnosed with aspiration pneumonitis. His symptoms improved after feeding via an NG tube. An esophagogram at the local hospital suspected a tracheoesophageal fistula with a faint shadow of the fistulous tract, 2 centimeters above the clavicular level. With a high index of suspicion, the child was scheduled for a rigid tracheo-bronchoscopy. After the fistula, located 2 centimeters above the carina, was identified and catheterized, a transcervical division of the fistula was performed. The child had an uneventful postoperative course and could catch up with standard growth within six months of follow-up.