Tracheoesophageal Fistulas

Clinical

Congenital tracheoesophageal (TE) fistulas result from failure of the esophageal lumen to develop completely separate from the trachea. Embryonically, the trachea and upper GI tract have a common origin at the caudal end of the embryonic pharynx. In normal development during the second month of gestation, the esophagus assumes a dorsal position, while the trachea lies ventrally. Failure of this complete separation leads to the development of TE fistulas. Below is a diagram depicting the different type of congenital TE fistulas and their frequency of occurrence. Esophageal atresia (EA) is a common cause of polyhydramnios in utero. At birth, the infant may have difficulty handling secretions and may have respiratory distress at first feeding. Attempts to pass a nasogastric tube are usually unsuccessful. Infants with TE fistulas tend to have rounded abdomens and bowel sounds, while those with EA without a fistula tend to have scaphoid abdomens and absent bowel sounds.

Radiological findings

For patients with EA and no TE fistula, barium studies are performed through a gastrostomy tube to define the length of the lower esophageal segment before surgery. In patients with proximal fistulas, nonionic water-soluble contrast is injected through a feeding tube in the upper esophageal pouch.

In image "A" we can see atresia of the upper esophagus as evidenced by failure to pass a feeding tube down the esophagus, but we still observe gas in the abdomen. These findings are likely due to a esophageal atresia with a distal tracheoesophageal fistula. Images "B, C, D" show contrast filling a blind pouch.