00:01
In this lecture, we’re going to
discuss tracheoesophageal fistula.
00:06
So TEF or tracheoesophageal fistula
is an abnormal congenital connection
between the trachea and the esophagus.
00:16
There are five types.
00:19
Type 1 is by far the most common.
00:22
This is an atresia with a fistula
between the distal esophagus
and the trachea as
is pictured here.
00:29
You can see the esophagus
basically stops.
00:33
The stomach is connected to trachea.
00:36
So these patients will
show up very, very early.
00:39
Their first meal, it ain’t going anywhere.
They’ll spit up.
00:44
A smaller percentage, 8%, have a
completely atretic stomach and esophagus.
00:50
In other words, there’s not fistula.
00:52
There’s simply a blind and looped
esophagus and a blind and looped stomach.
00:57
These infants should have no gas bubbles
in their intestines on an X-ray,
and will spit up very
quickly after eating.
01:03
This represents 8%.
01:05
You can see we’ve already accounted for
most of tracheoesophageal fistula.
01:10
Almost the rest are the third type
and this is an H type of fistula.
01:16
The H type fistula is
basically a connection
between the trachea
and the esophagus.
01:23
There’s a little bridge.
01:25
So these infants are interesting and that
they can present a little bit later on.
01:31
Basically, at some point, their gastric
contents do dribble into the lungs
and they get respiratory
distress often with eating.
01:39
So this is fistula
without any atresia
compared too the last one, which was
an atresia without any fistula.
01:46
There are two other very rare
types that you might hear about.
01:50
One is where the proximal
esophagus feeds into the trachea.
01:54
There is no path to the stomach.
01:57
The other is the same except
there is a path to the stomach,
the proximal esophagus
enters the trachea
and then the distal esophagus arises from
the trachea a little bit farther down.
02:10
When we see TEF, about half of patients
will have an associated anomaly.
02:16
An example might be CHARGE syndrome.
02:19
In CHARGE syndrome,
they may have coloboma as you can see
in this patient here with that black
pupil that’s extending down
in the patient’s left eye.
02:28
They may have heart defects or an
atresia such as choanal atresia.
02:33
Or they may have retardation or what we
like to call intellectual disability.
02:38
They may have genital malformations
or they may have ear anomalies.
02:42
CHARGE, C-H-A-R-G-E, and those
are symptoms they may have.
02:47
They may also have
tracheoesophageal fistula.
02:51
Another defect more classically associated
with tracheoesophageal fistula is VACTERL.
02:57
Again, each of these letters count for
a symptom that these patients have.
03:01
V is vertebral defects.
03:03
A is anal atresia.
03:05
C is cardiac defects,
particularly a VSD and the TE stand
for tracheoesophageal fistula.
03:14
They also have renal
anomalies or malformations
and they have limb defects such as radial
dysplasia, polydactyly or syndactyly.
03:24
So most TEF presents almost
immediately after birth.
03:30
These patients have food that cannot
get into the stomach in most cases.
03:35
This results in immediate emesis and
rapid dehydration outside of the uterus.
03:41
Additionally, gastric contents may enter the
lungs resulting in respiratory distress.
03:49
So the diagnosis of TEF
is usually made because it’s impossible
to get the NG tube into the stomach.
03:56
These infants are sick.
03:58
We place an NG in and we can’t
get it into the stomach.
04:01
Instead it coils up in
the proximal esophagus.
04:04
So we put in the NG, we take an x-ray and,
wow, look at that NG,
it didn’t go in.
04:09
Maybe this child has a TEF.
04:12
Alternatively we can make a more
definitive diagnosis by doing endoscopy.
04:18
We scope, we look down
there, it’s a blind loop.
04:22
So the H type fistula
is the one I think that
comes to mind the most often
because it’s more subtle.
04:31
This is only four percent
of all cases of TEF.
04:35
But this one can present later on in life.
04:38
It’s basically a fistula that’s small.
04:41
So there can be a delay in diagnosis.
04:44
Patients present with coughing, wheezing,
and struggling with feeds and reflux.
04:51
As you can see in this picture,
the food goes down the esophagus
and then somehow gets into the
trachea and can cause problems.
04:59
Some of the food keeps going.
05:03
So that’s my summary
of TEF in children.
05:07
Thanks for your time.