Tracheoesophageal fistula after primary repair of type C esophageal atresia in the neonatal period: recurrent or missed second congenital fistula.
OBJECTIVE
The aim of the study is to investigate whether a tracheoesophageal fistula (TEF) found after the primary repair of type C esophageal atresia (EA) is a recannulation of the original fistula, a missed proximal fistula, or other rare foregut malformation.


METHODS
Between 2000 and 2009, 143 different types of patients with EA were admitted in our hospital. Seven patients (2 from our series, 5 referred to us by other hospitals with the history of primary repair of type C EA) had late presenting TEF. Esophagogram, 3-dimensional computed tomographic (CT) reconstruction, bronchoscopy, and reoperation were performed to confirm the TEF. Their medical records were reviewed and summarized.


RESULTS
Persistent feeding or respiratory problems were the common symptom. The mean age of the first appearance was 17 ± 26 (1-63) months. Preoperative diagnosis was made by esophagograms and bronchoscopy in 6 patients. Reoperations were performed in all patients through thoracotomy. Missed proximal TEF shown as a distinct fistula above the primary anastomosis without much adhesion was confirmed in 5 cases. A recurrent TEF was found in 1 case. A case of communicating bronchopulmonary foregut malformation was confirmed by 3-dimensional CT reconstruction and reoperation.


CONCLUSIONS
A missed proximal TEF after repair of EA may be misdiagnosed as a recurrent TEF. Accurate preoperative diagnosis depends on combined evaluations of radiologic contrast study, 3-dimensional CT, and bronchoscopy.
Department of Surgery, Beijing Children's Hospital affiliated to Capital University of Medical Sciences, Beijing 100045, People's Republic of China. guo_weihong@163.com
Weihong
W
Guo
Yingzi
Y
Li
Anxia
A
Jiao
Yun
Y
Peng
Dawei
D
Hou
Yongwei
Y
Chen
D000015:Abnormalities, Multiple; D000402:Airway Obstruction / Q000209:etiology; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000002:abnormalities; D001999:Bronchoscopy; D003371:Cough / Q000209:etiology; D003951:Diagnostic Errors; D004933:Esophageal Atresia / Q000145:classification / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014138:Tracheoesophageal Fistula / Q000145:classification / Q000151:congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology