Adv Pediatr Surg.  2018 Dec;24(2):94-99. 10.13029/aps.2018.24.2.94.

Double H-type Tracheoesophageal Fistulae: A Case Report

• Sim J
• Hong J

• KMID: 2429806
• DOI: http://doi.org/10.13029/aps.2018.24.2.94

Abstract

We present an extremely rare case with double H-type tracheoesophageal fistulae identified with a time-lapse and repaired separately. A newborn male presented with cyanosis after breastfeeding. Contrast esophagogram demonstrated an H-type fistula, and then it was repaired in a standard fashion via right thoracotomy. When routine esophagogram was taken on postoperative day 10, another fistula was noticed at a level higher than the previous one. Bronchoscopy was performed to evaluate the lesion whether it was a recurred fistula or a second H-type fistula. However, it was so tiny that it was not visible with bronchoscopy. It was discovered only two months later when the fistula had grown up with the baby. The second H-type fistula was repaired through a cervical incision. Although double H-type fistulae are extremely rare, the possibility of another fistula, as well as recurrence, must be ruled out when symptom recurs after a definitive operation of an H-type fistula.

Keyword

H-type; Tracheoesophageal fistula; Bronchoscopy

MeSH Terms

Breast Feeding
Bronchoscopy
Cyanosis
Fistula
Humans
Infant, Newborn
Male
Recurrence
Thoracotomy
Tracheoesophageal Fistula*

Figure

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  Fig. 1 Two days after birth (right), chest radiograph shows aspiration pneumonitis which was absent on the date of birth (left).

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  Fig. 2 H-type tracheoesophageal fistula at 1 cm above the carina (white arrows).

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  Fig. 3 Another H-type fistula at T2 level.

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  Fig. 4 Rigid bronchoscopy just before 2nd operation showing a fistula opening. Suture material was visible at 2–3 cm below the catheter (white and black arrowheads).

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