title: Double H-type tracheoesophageal fistulas identified and repaired in 1 operation.
abstract: Isolated tracheoesophageal ("H-type") fistula is a relatively uncommon congenital anomaly that can be difficult to identify and, at times, challenging to repair. We present a very unusual case of an infant with 2 distinct H-type tracheoesophageal fistulas (TEFs) identified and repaired in 1 operation. A newborn male infant presented with coughing with feeds. Contrast esophagram demonstrated an intrathoracic H-type fistula without esophageal atresia. In the operating room, rigid bronchoscopy was performed, and a second TEF was identified in the cervical region. A separate balloon catheter was placed in each fistula. The intrathoracic fistula was repaired through a thoracotomy incision, and the more proximal fistula was repaired through a cervical incision. Each repair was uncomplicated, and recovery was uneventful. Double H-type tracheoesophageal appears to be extremely rare. This case underscores the importance of searching for a second fistula by bronchoscopy before undertaking definitive repair of a TEF.
authors.affiliation: General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. mattei@email.chop.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Mattei
mesh_terms: D001999:Bronchoscopy; D004944:Esophagoplasty / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013908:Thoracotomy; D014132:Trachea / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000175:diagnosis / Q000601:surgery*