Cases reported "Tracheoesophageal Fistula"

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1/90. Esophageal lung with multiple congenital anomalies: conundrums in diagnosis and management.

    BACKGROUND/PURPOSE: Communicating bronchopulmonary foregut malformations (CBPFM) are a diverse group of potentially devastating congenital anomalies with anatomy that may be difficult to delineate. The authors present a case that illustrates conundrums in the diagnosis and management of these complex disorders. methods: A term baby had esophageal atresia (EA), tracheoesophageal fistula (TEF), and tetralogy of fallot. Initially, a gastrostomy was performed, and a balloon catheter was inserted through the endotracheal tube to occlude the fistula until the patient was hemodynamically stable. Subsequently, the fistula was ligated. Postoperatively, the left lung collapsed, and bronchoscopy showed an atretic left mainstem bronchus. Repeat thoracotomy showed that the fistula ligation was intact. air was introduced through the gastrostomy tube, and, surprisingly, the left lung inflated, indicating the left mainstem bronchus arose from the esophagus distal to the ligated TEF. RESULTS: Despite reopening this fistula, ventilation remained poor, and support was withdrawn. autopsy findings confirmed a unilobed left lung arising from the esophagus, EA, TEF, an atretic left mainstem bronchus, tetralogy of fallot, and digeorge syndrome. CONCLUSIONS: This is the first report of a combination of EA and distal TEF with a second CBPFM involving the esophagus and the entire left lung. Successful correction of these anomalies will require extensive delineation of the anatomy to plan an operative strategy.
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2/90. Congenital cystic adenomatoid malformation of the lung associated with esophageal atresia and tracheoesophageal fistula.

    Bronchopulmonary malformations associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF) are extremely rare. The authors describe a case of type II congenital cystic adenomatoid malformation (CCAM) of the right lower lobe associated with EA and TEF (Vogt-Gross type C) in a full-term female infant. The CCAM presented as an incidental radiologic finding, and a contralateral tension pneumothorax developed shortly after surgical repair of the EA. Early recognition of this rare association is essential for correct operative management.
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3/90. Gastric tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap.

    A gastric tube-to-airway fistula is a very rare complication after esophageal reconstruction. A patient with a gastric tube-to-tracheal fistula that developed more than 9 years after surgery for cancer of the cervical esophagus was treated with transposition of a pedicled latissimus dorsi myocutaneous flap. Careful perioperative respiratory management helped save the patient's life.
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4/90. Acquired tracheoesophageal fistula in critically ill patients.

    Acquired benign tracheoesophageal fistula (TEF) is an infrequent complication of prolonged intubation and tracheostomy. Not infrequently, it is associated with severe circumferential malacia of the trachea and a need for concomitant correction of both. Controversy exists as to whether this should be performed in a single-stage or a 2-stage procedure. Four patients with acquired TEF underwent operation in a tertiary referral medical center between 1995 and 1997. The operations were performed through either an anterior (3) or a lateral (1) neck approach. Three patients underwent closure of the fistula with tracheal resection and anastomosis in a single stage and are doing well. One patient with complete subglottic stenosis underwent closure of the TEF and was planned for tracheal reconstruction in a second stage. This patient died in the early postoperative period. The complications included aspiration of blood leading to pneumonia (2), spontaneously resolving pneumomediastinum (1), subcutaneous emphysema (2), and cardiac arrhythmia ( 1). Residual fistula, noted in 1 patient, was treated conservatively and resolved spontaneously within several weeks. We conclude that acquired TEF is amenable to repair through a cervical approach. A single-stage correction of the TEF with reconstruction of the trachea is suitable and successful in most patients. Several stages seem justified when concurrent laryngotracheal reconstruction is needed.
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5/90. tracheoesophageal fistula after blunt chest trauma: successful diagnosis by computed tomography.

    A case of tracheoesophageal fistula after blunt trauma is reported. A 27-year-old man who suffered from an automobile traffic accident complained of strong choking after drinking water. Computed tomography demonstrated a defect between the esophagus and the trachea just above the carina. Acquired tracheoesophageal fistula was suspected and promptly confirmed by contrast esophagogram. The defects of the trachea and esophagus was repaired by primary suture and buttressed using a pedicled intercostal flap. The postoperative course was uneventful.
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6/90. Chyloperitoneum: a postoperative complication after repair of tracheoesophageal fistula.

    Chyloperitoneum is rare condition that can occur in response to various pathologic process. The authors described a newborn baby who had chyloperitoneum after primary surgical repair of esophageal atresia with tracheoesophageal fistula (Gross type C). This probably resulted from iatrogenic damage of the thoracic duct during ligation of azygous vein resulting in leaking lacteal within the intestinal wall. Biochemical analysis of ascitic fluid, plasma, and milk formula for triglyceride and cholesterol level can differentiate neonatal gastric intestinal perforation.
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7/90. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy.

    BACKGROUND: Benign tracheo-neo-esophageal fistulas after esophagectomy are rare and treatment can be challenging. They can result from perioperative tracheal injury or various postoperative complications. methods: charts of 6 patients with a benign tracheoneo-esophageal fistula after subtotal esophagectomy treated in this institution between July 1993 and August 1999 were analyzed. RESULTS: Three men and 3 women (median age 61 years) developed a fistula after subtotal esophagectomy. Symptoms varied from mild swallowing difficulties to aspiration pneumonia and mediastinitis. Two patients with mild symptoms were treated conservatively. In 1 patient a long fistula was partly excised through the neck. In 3 patients the gastric tube was excluded or excised, with surgical closure of the tracheal defect. The alimentary tract was reconstructed by colonic interposition. There were no major complications. After a median follow-up of 1.6 years, all fistulas were closed. All patients were capable of sufficient oral intake. CONCLUSIONS: A benign tracheo-neo-esophageal fistula after esophagectomy is a rare, but serious complication. Site and size of the fistula, together with the severity of symptoms, should dictate management.
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8/90. H-type tracheo-oesophageal fistula: appearance on three-dimensional computed tomography and virtual bronchoscopy.

    H-type tracheo-oesophageal fistula (TOF) is a rare type of fistula without oesophageal atresia. The symptoms are usually present at birth, but the diagnosis is often delayed. Traditionally, contrast oesophagography and/or fiberoptic bronchoscopy are used to confirm the diagnosis. We describe the imaging features of a case of H-type TOF seen on three-dimensional computed tomography and virtual bronchoscopy and the usefulness of these techniques in pre-operative evaluation.
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9/90. A new variant of esophageal atresia associated with esophageal heterotopic pancreas.

    An infant with esophageal atresia (EA) and absence of gas on abdominal radiographs was found to have an obliterated distal tracheoesophageal fistula (TEF). Preoperative bronchoscopy and surgical exploration found that the reason for gasless abdomen was the atresia of the distal portion of lower esophagus, which also contained heterotopic pancreatic tissue. The type of trachea/esophageal anomaly found in this patient, with the association of esophageal heterotopic pancreas (EHP), has not yet been reported in the literature.
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10/90. Congenital bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia.

    A case of initial esophageal atresia and tracheoesophageal fistula in a female newborn, later complicated by pneumonia and a second bronchoesophageal fistula, is reported. She was treated surgically by closure of the tracheoesophageal fistula and by end-to-end esophago-esophageal anastomosis. An esophagram at 1 month of age was normal. Three months later she developed severe, persistent right lower lobe pneumonia that required intensive antibiotic therapy and respiratory support. Esophagography was repeated and revealed a second fistula between the right main-stem bronchus and the lower esophagus. The bronchoesophageal fistula was repaired, and a right lower lobectomy was performed. Postoperative recovery was uncomplicated. Histologic examination indicated that the fistula was congenital in origin. To the best of our knowledge, this is the first reported case of a congenital bronchoesophageal fistula coexisting with a tracheoesophageal fistula and esophageal atresia.
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