Diagnostic difficulties in the management of H-type tracheoesophageal fistula.
OBJECTIVE
To evaluate the diagnostic difficulties and pitfalls in establishing the diagnosis of congenital H-type tracheoesophageal fistula.


METHODS
A retrospective review of all cases of H-type tracheoesophageal fistula that were diagnosed in a single unit over a 6-year period. The variables assessed were age at presentation, presenting symptoms, time to diagnosis, investigations, and time to surgical repair of H-type fistula. The investigations leading to a definitive diagnosis are assessed and discussed.


RESULTS
Between 1998 and 2004, five cases of H-type tracheoesophageal fistula presented to our unit. All cases had an upper gastrointestinal contrast study/tube esophagogram. In addition, four cases had a chest radiograph, three cases had a bronchoscopy, and one case an esophagoscopy. The median delay from the time of first presentation to diagnosis of H-type tracheoesophageal fistula was 14 days (7-58 days). Median age at surgery was 15 days (8-60 days).


CONCLUSIONS
Although symptoms are usually present from birth, the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic techniques are not entirely reliable and fistula identification can be elusive. The authors present recommendations for the diagnostic work-up, which may increase the diagnostic potential and avoid unnecessary delays in the diagnosis and management of H fistula.
Ng
J
J
Pediatric Surgical Unit and Department of Radiology, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
Antao
B
B
Bartram
J
J
Raghavan
A
A
Shawis
R
R
D000367:Age Factors; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery