Top

Pediatric Surgery International

Published in:

01-12-2023 | Oesophageal Atresia | Original Article

Clinical features of a tracheoesophageal fistula associated with complete tracheal rings

Authors: Keiichi Morita, Tadashi Hatakeyama

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Purpose

A tracheoesophageal fistula (TEF) associated with complete tracheal rings (CTR) is extremely rare. This study aimed to elucidate the clinical features of this combination.

Methods

Records of 39 patients diagnosed with TEF with or without CTR between January 2013 and February 2023 were retrospectively reviewed. Data collected included location of the TEF and CTR, esophageal gap, surgery of TEF/esophageal atresia (EA), and symptoms of CTR.

Results

Seven patients had CTR, while 32 patients did not have CTR. TEF was frequently located higher than the T4 vertebra, and the median esophageal gap was shorter in patients with CTR than in those without (5/7 [71.4%] vs. 6/32 [18.8%], P = 0.012; 0 (range: 0–15) mm vs. 13.3 (range: 0–40) mm, P = 0.017, respectively). TEF was located just above the beginning of the CTR in all patients. All patients with CTR underwent primary esophageal anastomosis. Additionally, two patients were diagnosed with CTR before TEF/EA repair. A tracheal tube was prevented from contacting the CTR during TEF/EA repair, and respiratory insufficiency did not occur.

Conclusions

Our results may help pediatric surgeons in the management of TEF with CTR.

Shaw-Smith C (2006) Oesophageal atresia, tracheo-oesophageal fistula, and the VACTERL association: review of genetics and epidemiology. J Med Genet 43:545–554. https://doi.org/10.1136/jmg.2005.038158CrossRefPubMed

Rothenberg S (2014) Esophageal atresia and tracheoesophageal fistula malformations. In: HolcombMurphy GWJP, Ostlie DJ (eds) Ashcraft’s pediatric surgery. Elsevier Inc, London, pp 365–384

Hofferberth SC, Watters K, Rahbar R, Fynn-Thompson F (2015) Management of congenital tracheal stenosis. Pediatrics 136:e660-669. https://doi.org/10.1542/peds.2014-3931CrossRefPubMed

Herrera P, Caldarone C, Forte V, Campisi P, Holtby H, Chait P, Chiu P, Cox P, Yoo SJ, Manson D, Kim PC (2007) The current state of congenital tracheal stenosis. Pediatr Surg Int 23:1033–1044. https://doi.org/10.1007/s00383-007-1945-3CrossRefPubMed

Chiu PP, Kim PC (2006) Prognostic factors in the surgical treatment of congenital tracheal stenosis: a multicenter analysis of the literature. J Pediatr Surg 41:221–225. https://doi.org/10.1016/j.jpedsurg.2005.10.043CrossRefPubMed

Borland LM, Reilly JS, Smith SD (1987) Anesthetic management of tracheal esophageal fistula with distal tracheal stenosis. Anesthesiology 67:132–133. https://doi.org/10.1097/00000542-198707000-00030CrossRefPubMed

Usui N, Kamata S, Ishikawa S, Sawai T, Okuyama H, Imura K, Okada A (1996) Anomalies of the tracheobronchial tree in patients with esophageal atresia. J Pediatr Surg 31:258–262. https://doi.org/10.1016/s0022-3468(96)90010-xCrossRefPubMed

Lam WW, Tam PK, Chan FL, Chan KL, Cheng W (2000) Esophageal atresia and tracheal stenosis: use of three-dimensional CT and virtual bronchoscopy in neonates, infants, and children. Am J Roentgenol 174:1009–1012. https://doi.org/10.2214/ajr.174.4.1741009CrossRef

Rutter MJ, Cotton RT, Azizkhan RG, Manning PB (2003) Slide tracheoplasty for the management of complete tracheal rings. J Pediatr Surg 38:928–934. https://doi.org/10.1016/s0022-3468(03)00126-xCrossRefPubMed

10.

Seguier-Lipszyc E, Dauger S, Malbezin S, Aigrain Y, de Lagausie P (2005) Reimplantation of oesophageal bronchus following a type III oesophageal atresia repair. Pediatr Surg Int 21:649–651. https://doi.org/10.1007/s00383-004-1359-4CrossRefPubMed

11.

Tsugawa J, Tsugawa C, Satoh S, Nishijima E, Muraji T, Takamizawa S, Kanegawa K, Akasaka Y (2005) Communicating bronchopulmonary foregut malformation: particular emphasis on concomitant congenital tracheobronchial stenosis. Pediatr Surg Int 21:932–935. https://doi.org/10.1007/s00383-005-1520-8CrossRefPubMed

12.

Le Bret E, Roubertie F, Roger G, Sigal-Cinqualbre A, Coblence M, Belli E, Gharbi N, Roussin R, Garabédian EN, Serraf A (2009) Slide tracheoplasty in infant with congenital tracheal stenosis and tracheomalacia after esophageal atresia with tracheoesophageal fistula repair. J Pediatr Surg 44:e15-17. https://doi.org/10.1016/j.jpedsurg.2009.04.004CrossRefPubMed

13.

Antón-Pacheco JL, Kalicinski P, Kansy A, Maruszewski P (2012) Slide tracheoplasty in an infant with congenital tracheal stenosis and oesophageal atresia with tracheoesophageal fistula. Eur J Cardiothorac Surg 42:892–893. https://doi.org/10.1093/ejcts/ezs354CrossRefPubMed

14.

Wu ET, Wang CC, Lin MT, Huang PM, Chen SJ, Huang CH, Hwang HK, Chen MR, Huang SC (2013) Concomitant slide tracheoplasty and cardiac operation for congenital tracheal stenosis associated with VACTERL. Ann Thorac Surg 96:1492–1495. https://doi.org/10.1016/j.athoracsur.2013.04.122CrossRefPubMed

15.

Stock C, Nathan M, Murray R, Rahbar R, Fynn-Thompson F (2015) Modified end-to-end anastomosis for the treatment of congenital tracheal stenosis with a bridging bronchus. Ann Thorac Surg 99:346–348. https://doi.org/10.1016/j.athoracsur.2014.06.084CrossRefPubMed

16.

Siddiqui A, Wolter NE, Matava C (2020) Use of an aortic cannula for tracheal intubation in a patient with severe tracheal stenosis and tracheoesophageal fistula: a case report. Cureus 12:e9456. https://doi.org/10.7759/cureus.9456CrossRefPubMedPubMedCentral

17.

Morita K, Kawahara I, Yashita H, Hatakeyama T (2022) Right esophageal lung with esophageal atresia and left bronchial stenosis. Pediatr Int 64:e14982. https://doi.org/10.1111/ped.14982CrossRefPubMed

18.

Wolter NE, Kennedy AA, Rutter MJ, Matava C, Honjo O, Chiu PL, Propst EJ (2020) Diagnosis and management of complete tracheal rings with concurrent tracheoesophageal fistula. Int J Pediatr Otorhinolaryngol 133:109971. https://doi.org/10.1016/j.ijporl.2020.109971CrossRefPubMed

19.

Holzki J (1992) Bronchoscopic findings and treatment in congenital tracheoesophageal fistula. Paediatr Anaesth 2:297–303. https://doi.org/10.1111/j.1460-9592.1992.tb00220.xCrossRef

20.

Shimojima N, Shimotakahara A, Tomita H, Harumatsu T, Harada A, Maeda Y, Ito Y, Miyaguni K, Tsukizaki A, Abe K, Hashimoto M, Ishikawa M, Honda M, Kuroda T, Hirobe S (2022) Outcomes of slide tracheoplasty for congenital tracheal stenosis in 80 children: a 22-year single-center experience. J Pediatr Surg 57:1205–1209. https://doi.org/10.1016/j.jpedsurg.2022.02.033CrossRefPubMed

21.

Taghavi K, Stringer MD (2018) Preoperative laryngotracheobronchoscopy in infants with esophageal atresia: why is it not routine? Pediatr Surg Int 34:3–7. https://doi.org/10.1007/s00383-017-4194-0CrossRefPubMed

22.

Sharma N, Srinivas M (2014) Laryngotracheobronchoscopy prior to esophageal atresia and tracheoesophageal fistula repair-its use and importance. J Pediatr Surg 49:367–369. https://doi.org/10.1016/j.jpedsurg.2013.09.009CrossRefPubMed

23.

Antón-Pacheco JL, Cano I, Comas J, Galletti L, Polo L, García A, López M, Cabezalí D (2006) Management of congenital tracheal stenosis in infancy. Eur J Cardiothorac Surg 29:991–996. https://doi.org/10.1016/j.ejcts.2005.12.061CrossRefPubMed

24.

Tsang V, Murday A, Gillbe C, Goldstraw P (1989) Slide tracheoplasty for congenital funnel-shaped tracheal stenosis. Ann Thorac Surg 48:632–635. https://doi.org/10.1016/0003-4975(89)90777-7CrossRefPubMed

25.

Grillo HC (1994) Slide tracheoplasty for long-segment congenital tracheal stenosis. Ann Thorac Surg 58:613–619. https://doi.org/10.1016/0003-4975(94)90714-5CrossRefPubMed

26.

Morita K, Maeda K, Yabe K, Oshima Y (2017) Management of congenital tracheal stenosis in the neonatal period. Pediatr Surg Int 33:1059–1063. https://doi.org/10.1007/s00383-017-4137-9CrossRefPubMed

27.

Garge S, Rao KL, Bawa M (2013) The role of preoperative CT scan in patients with tracheoesophageal fistula: a review. J Pediatr Surg 48:1966–1971. https://doi.org/10.1016/j.jpedsurg.2013.06.010CrossRefPubMed

28.

Garge S, Rao KL, Bawa M (2013) Role of preoperative 3D CT reconstruction for evaluation of patients with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 48:1966–1971. https://doi.org/10.1016/j.jpedsurg.2013.06.010CrossRefPubMed

Title: Clinical features of a tracheoesophageal fistula associated with complete tracheal rings
Authors: Keiichi Morita
Tadashi Hatakeyama
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Oesophageal Atresia
Esophageal Atresia
Bronchoscopy
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05503-0

2024 ASCO Annual Meeting

Springer Medicine

Clinical features of a tracheoesophageal fistula associated with complete tracheal rings

Abstract

Purpose

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Quantitative evaluation of pediatric umbilical loop stomas: 2 decades of experience from a single institution

Beyond the diaphragm and the lung: a multisystem approach to understanding congenital diaphragmatic hernia

Adolescent experiences of the safe surgical checklist and surgical care processes

Differentiating abdominal pain due to COVID-19 associated multisystem inflammatory syndrome from children with acute appendicitis: a score system

Association between gastrointestinal perforation and patent ductus arteriosus in extremely-low-birth-weight infants: a retrospective study of our decade-long experience

Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation