title: Near-missed upper tracheoesophageal fistula in esophageal atresia.
abstract: Upper pouch tracheoesophageal fistula (TEF) accompanying esophageal atresia (EA) occurs in less than 1% of all EA/TEF variants and could be easily missed after birth. To confront such diagnostic inaccuracy, perioperative tracheobronchoscopy (TBS) and preoperative upper pouch esophagogram (UPEG) have been proposed but are still controversial. We describe the role of UPEG and TBS, used early after birth, in two cases of EA/TEF with upper pouch TE fistulas with unusual high location (one intrathoracic, one subglotic). These upper TE fistulas were almost missed but ultimately detected very early while employing both UPEG and TBS, wherein UPEG was for the diagnosis of TEF and TBS for both intraoperative diagnostic confirmation and aid in TEF identification. We conclude that UPEG and TBS are complementary in detecting near-missed upper TE fistula accompanying EA. Such approach ensures early and accurate diagnosis of EA/TEF variants, thus preventing the complications of a missed congenital upper pouch TE fistula.
authors.affiliation: Department of Pediatric Surgery, Meyer Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa 31096, Israel. g_shoshany@rambam.health.gov.il
authors.forename: Gideon
authors.initials: G
authors.lastname: Shoshany
authors.forename: Arkadi
authors.initials: A
authors.lastname: Vatzian
authors.forename: Anat
authors.initials: A
authors.lastname: Ilivitzki
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.forename: Fahed
authors.initials: F
authors.lastname: Hakim
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
mesh_terms: D001999:Bronchoscopy; D004933:Esophageal Atresia / Q000175:diagnosis* / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D014138:Tracheoesophageal Fistula / Q000175:diagnosis* / Q000601:surgery