Issue N# 4 - 2006
PAEDIATRICS
Isolated tracheo-œsophageal fistula in neonates.
Authors : D. Bakhos, S. Morinière, E. Merieau, H. Lardy, E. Saliba, E. Lescanne (Tours)
Ref. : Rev Laryngol Otol Rhinol. 2006;127,4:259-262.
Article published in french 
Downloadable PDF document french
Summary :
Introduction: Congenital isolated tracheo-œsophageal fistulae without œsophageal atresia account for about 4% of tracheo-œsophageal malformations. An Otolaryngologist, even with a paediatric practice, is unlikely to treat a lot of cases during his career. We report 3 cases and discuss the investigations and management of the fistulae. Patients and methods: Three neonates with an isolated congenital tracheo-œsophageal fistula were treated between 1997 and 2002. We describe their presentation, investigation and treatment. We present radiology, endoscopic and surgical images for one case. Results: The mean age at diagnosis of congenital isolated fistula was 6.7 days. In retrospect, the symptoms were usually present from birth. A barium swallow had demonstrated the tracheo-oesophageal fistula in 2 infants. In all three cases the fistula was clearly visualized by tracheoscopy. The most distal fistula was 25 millimetres below the true vocal cords. The closure of the fistula was made by cervicotomy in all cases. Our results are discussed with regards to the literature. Conclusion: Congenital tracheo-œsophageal fistulae are rare malformations. Diagnostic delay is common. Tracheo-œsophageal endoscopy is the investigation of choice. Good results are obtained with surgery treatment via a cervical approach. The management of such fistulae requires medical teams familiar with neonatal endoscopy and cervical surgery.
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