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Background: Segmented self-expanding metal stents (SEMS) are an alternative to conventional unsegmented SEMS in the treatment of esophageal strictures. Due to their segmented design, they may adapt better to the surrounding structures making them less likely to migrate or cause trauma. We examined if there are clinically relevant differences between segmented and conventional esophageal SEMS in benign and malignant stenosis in terms of their functionality and safety. Patients and methods: We performed a multicenter, retrospective case–control study of segmented and conventional SEMS implantations in esophageal stenosis. Outcome parameters were adverse events such as migration, occlusion, and severe complications (i.e., bleeding and perforation). Results: 79 segmented SEMS were identified and compared to 79 conventional SEMS implantations. Groups were similar in terms of age, gender, and etiology. We observed 13.9% severe complications (SEMS-associated clinically significant bleeding or perforation) in the conventional SEMS group compared to 3.8% in the segmented SEMS group. This difference was statistically significant (p = 0.025). Rates of migration and occlusion were similar between both groups. Likewise, there was no significant difference in terms of short-term (30 days) clinical success. Conclusion: In this first controlled analysis, segmented SEMS were associated with fewer severe clinical complications compared to conventional SEMS. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate different surgical approaches to long-gap esophageal atresia (LGEA) with or without tracheoesophageal fistula (TEF) is unclear. Methods: A systematic literature review was done comparing gastric transposition versus esophageal lengthening with delayed primary anastomosis in infants with LGEA+/-TEF. The primary outcome was time to full oral feeds. Secondary outcomes were time to full enteric feeds, need for further surgery, growth, mortality, and postoperative adverse events. Results: No comparative studies were found. However, the literature was re-interrogated for non-comparative studies. Four hundred thirty-eight articles were identified and screened, and 18 met the inclusion criteria. All were case series. Forty-three infants underwent gastric transposition, and 106 had esophageal lengthening with delayed primary anastomosis. One study on gastric transposition reported time to full oral feeds, and one study in each group reported growth. Time to full enteric feeds was reported in one study in each group. 30% of infants had further surgery following gastric transposition, including hiatus hernia repair (5/43, 12%) and esophageal dilation (7/43, 16%). Following esophageal lengthening, 62/106 (58%) had anti-reflux surgery, 58/106 (55%) esophageal dilatation and 11/106 (10%) esophageal stricture resection. Anastomotic complications occurred in 13/43 (30%), gastrointestinal in 16/43 (37%), respiratory in 17/43 (40%), and nerve injury in 2/43 (5%) of the gastric transposition group. In the esophageal lengthening group, anastomotic complications occurred in 68/106 (64%), gastrointestinal in 62/106 (58%), respiratory in 6/106 (6%), and none sustained nerve injury. Each group had one death due to a cause not directly related to the surgical procedure. Conclusions: This systematic review highlights the morbidity associated with both surgical procedures and the variety in reporting outcomes. [ABSTRACT FROM AUTHOR]

To determine the incidence, management and outcomes of esophageal atresia/tracheo-esophageal fistula (EA/TEF) over a 15-y period in South Africa. A retrospective chart review of neonates with EA/TEF presenting at the main tertiary referral hospital in the KwaZulu-Natal province between 2002 and 2017 was conducted. Data collection comprised patient and maternal demographics, clinical presentations, laboratory and radiologic investigations, surgical procedures, and outcomes. A multivariate logistic regression determined the risk factors associated with mortality. Among 180 neonates, mean (SD) age of diagnosis was four (three) days postnatal with Gross Type C (n = 165, 92%) being the most common and the incidence was one per 10,000 live births. Majority were born term (n = 95, 53%) at peripheral hospitals (n = 167, 93%) with a mean birth weight of 2369 (736) grams. Overall HIV exposure rate was 27% (n = 48). Most (n = 138, 77%) patients presented with established pneumonia, 44% (n = 61) of whom required prolonged (>7 d) ventilator support. The median (IQR) hospital stay was 11 (8-20) d. Overall survival rate was 70% (n = 126). Birth weight <1500 g, life threatening anomalies, ventilation >30 d and postoperative sepsis contributed to mortality. Incidence, disease types and presentations were similar to developed countries. Despite advances in technology and neonatal care in Africa, EA/TEF surgical outcomes remain suboptimal likely due to caregivers' inability to care for these infants in disadvantaged socioeconomic circumstances with poor sanitation, etc. Research is needed to identify strategies tailored for disadvantaged communities which may contribute to improved outcomes in the perioperative and postoperative period. [ABSTRACT FROM AUTHOR]

Acquired Tracheo-esophageal fistula (TEF) is a challenging and complicated condition. The laryngeal protection is lost in acquired TEF cases due to the established connection between the esophagus and the airways leading to aspiration, pneumonia, and acute respiratory distress syndrome. Malignancy contributes to about 80% of acquired TEF. Nonmalignant causes for TEF include prolonged ventilation, trauma (iatrogenic, penetrating, or blunt injury), foreign bodies, corrosive burns, and granulomatous infections. With the advancements in critical care, the incidence of TEF post-ventilation is on the rise in recent decades. We would like to share our experience managing ten cases of nonmalignant acquired cervical TEF by the lateral cervical approach at our institute. Apart from the isolated TEF cases, one patient with concomitant tracheal stenosis was repaired simultaneously with good postoperative results. TEF was identified in two cases following removal of T-tube and solid stent respectively and was repaired successfully with lateral cervical approach with strap muscle flap interposition. [ABSTRACT FROM AUTHOR]

Introduction Despite various improvements in technology and patient care, tracheal intubation and tracheostomy still result in significant tracheal injuries like stenosis and airway fistula. Pressure necrosis by the inflated balloon is the commonest culprit. Post-intubation tracheal stenosis is a major indication for tracheal resection and anastomosis. This study was done to find out the indications and results of surgery for post-intubation tracheal lesions. Methods It was a descriptive observational study of patients with postintubation tracheal lesions managed in Manmohan Cardiothoracic Vascular and Transplant Center over a period of 20 years (2001 to 2021). Results Twenty five patients were treated for post-intubation tracheal lesions. Four had isolated tracheo-esophageal fistula (TEF); eighteen had an isolated tracheal stenosis and three had both. Most had a tracheal resection and end-end anastomosis (REEA) via a cervical approach, resecting an average of 2.7 cm of tracheal length. The average size of stenotic lumen was 4.32 mm. There were no operative deaths. Two patients expired within a month of surgery: one due to fatal restenosis and the other due to sepsis. There were a few immediate and a few long-term complications. The average follow-up period was 5 years. Conclusion Among the various post-intubation lesions, tracheal stenosis is the commonest indications for surgery. The management is challenging but safe and feasible, with a multidisciplinary team approach. [ABSTRACT FROM AUTHOR]

We report a 49‐year‐old patient with COVID‐19 who developed lung abscess, pleural empyema, and tracheo‐esophageal fistula. He underwent cervicotomy, segmental tracheal resection, esophageal‐tracheal fistula excision, and suturing the esophagus, and a classic thoracotomy was performed. Despite the severe infection, the patient was discharged home after successful surgical treatment. [ABSTRACT FROM AUTHOR]

Radiation therapy for broncho-pulmonary malignancies can lead to fistula formation between the digestive and respiratory tracts. Treatment options have been largely palliative in nature. Here, we report a combined pneumonectomy and esophagectomy, followed by staged retrosternal gastric pull-up esophageal reconstruction, for treatment of a broncho-esophageal fistula with good functional outcomes following reconstruction. [ABSTRACT FROM AUTHOR]

Acquired tracheo-esophageal fistulas (TEFs) are challenging. The most common causes are prolonged intubation, malignancy, and trauma whereas granulomatous infections like tuberculosis are rare. Endoscopic intervention with esophageal or tracheal stenting or clipping is of unproven benefit in the management of such lesions, where surgical repair is almost invariably required. We report a case of a 32-year-old man, with a case of multidrug-resistant pulmonary tuberculosis. He had no history of malignancy or trauma. The patient developed spontaneous TEF probably due to mediastinal lymph node necrosis. Multiple attempts were made using staplers, clips, and atrial septal defect (ASD) device closure but were unsuccessful. The nuanced complication leads to very individualized course of treatment which was optimal for this patient. [ABSTRACT FROM AUTHOR]

Purpose We evaluated the various accompanied malformations in patients with anal atresia or tracheoesophageal fistula (TEF). Furthermore, we determined the prevalence of VACTERL association and compared the clinical findings with those of patients without VACTERL association. Methods: We enrolled the patients with anal atresia or TEF with/without esophageal atresia. We collected the patient data pertaining to accompanied vertebral, cardiovascular, renal or limb anomalies, single umbilical artery, maternal diabetes mellitus or drug history, and gene research. Results: A total 155 patients (65 boys and 90 girls) were enrolled with 147 cases of anal atresia, 3 cases of TEF, and 5 cases of anal atresia with TEF. The prevalence of accompanied anomalies was 67.1% in cardiovascular, 27.1% in renal, 9.7% in vertebral, 2.6% in limb anomalies, and 3.9% in single umbilical artery. Thirty‐six (23.2%) patients were diagnosed with VACTERL association. The patients with VACTERL association had a significantly higher number of male patients (58.3 vs. 37.0%, p =.033) and single umbilical artery (11.1 vs. 1.7%, p =.026), and had a significantly lower birth weight (2.8 vs. 3.1 kg, p =.033) than the patients without VACTERL association. Genetic studies were performed in 111 patients, and 8 (7.2%) had chromosomal abnormalities—3 in VACTERL and 5 in no VACTERL group. Conclusion: We recommend a careful evaluation for VACTERL association in patients with anal atresia or TEF. It is particularly important to screen for a single umbilical artery for features of VACTERL association as well as for other congenital anomalies. [ABSTRACT FROM AUTHOR]

Background: Improved surgical techniques, as well as pre and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) with trachea-esophageal fistula (TEF) over last decades. The increase in survival caused a number of young children with post-operative esophageal strictures referred for endoscopic management. Objective: To assess efficacy and safety of endoscopic dilatation of anastomotic strictures in patients with post-surgical repair of EA and TEF. Materials and methods: We retrospectively analyzed clinical endoscopic data of 52 patients with post-surgical anastomotic strictures from March 1994 to December 2019. All procedures were performed under local anesthesia with use of fluoroscopic guidance. Outcome parameters measured included the location of stricture, number of dilations, procedural success rates, and complications such as esophageal perforation. Results: Of 52 patients analyzed, 16 (31%) underwent dilatation with SG dilators used in initial part of the study i.e., from 1994 to 2004. With the availability of CRE balloons, further patients were dilated with CRE balloon 36/52 (69%). Strictures were located centrally in 46 patients (88.6%) and eccentrically in 6 patients (11.5%). Associated pseudodiverticula above the stricture noted in 14(26.9%). The number of dilatations varied from 2 to 16 sessions, mean being 6.3 sessions. Complications secondary to procedure were observed in 7 patients with fever in 4 (7.6%), minor bleed in 2(3.8%) and perforation in one (1.9%) and were treated conservatively. We have not encountered any mortality. No significant difference between SG dilators and CRE balloon group. Conclusions: Endoscopic dilatation of post-surgical esophageal strictures in patients with EA and TEF with SG dilators CRE balloon dilatation is safe and effective with less number of complications. Endoscopic dilatation under local lignocaine anesthesia is feasible, effective and safe. [ABSTRACT FROM AUTHOR]

Objectives: To highlight different patterns of clinical presentation, share authors' experience in the management of children following button battery ingestion and their outcomes. Methods: This is a single center descriptive cohort study with a total duration of 5 y (January 2014 through December 2018). Battery removal was performed by urgent rigid esophagoscopy following department protocols. Outcomes and complications were observed in the post-operative period in all children. Contrast esophagogram was performed at 4–6 wk post battery removal for assessing esophageal emptying and detecting sequelae (stricture). Results: Fifty-two children (M:F = 31:21) with a mean age (+SD) at presentation of 47 (+27) mo were managed at authors' center during the study period. Most common source of button battery was electronic appliance remote (50%) and common symptoms at presentation were vomiting after feeds, dysphagia, chest pain etc. During endoscopic retrieval, majority (60%) of the batteries were lodged in the upper esophagus and predominant impaction was noticed at anterior wall (81%) of esophagus. Upon injury assessment, grade 3 followed by grade 2 were detected in 59% and 41% cases respectively. Five children developed complications. Two deaths due to catastrophic hemorrhage (aorto-esophageal fistula) and refractory sepsis (tracheoesophageal fistula) occurred in present cohort. While contrast esophagogram was normal in all survivors, self-limiting symptoms like mild chest pain during swallowing and cough were observed during the follow-up. Median (IQR) duration of hospital stay and follow-up were 2 d (1–2.75) and 14.5 mo (8.5–17.5) respectively. Conclusions: Accidental button battery ingestion can be life-threatening. Diagnosis is often delayed due to non-specific clinical presentation and unwitnessed ingestions. Esophagoscopic retrieval is the treatment modality of choice. Despite having significant esophageal injury at the time of removal, no long-term sequelae (clinical or radiological) were observed in present study. [ABSTRACT FROM AUTHOR]

Combined endoscopical treatments for tracheo-esophageal fistula developed during V-V ECMO for severe COVID-19: A case series Keywords: Covid-19; ECMO; endoscopy; SARS-CoV 2; tracheo-esophageal fistula EN Covid-19 ECMO endoscopy SARS-CoV 2 tracheo-esophageal fistula 506 508 3 03/02/22 20220301 NES 220301 INTRODUCTION Patients affected with acute respiratory distress syndrome due to Covid-19 may require veno-venous extracorporeal membrane oxygenation (V-V ECMO), often undergoing tracheostomy.1,2 Tracheo-esophageal fistula (TEF) can develop as an immediate or late complication of tracheostomy, and can be enhanced by several conditions coexisting in severe Covid-19, such as malnutrition, soft tissue hypo-perfusion, need for high-dose vasopressors, mechanical damage during prone position, long hospitalization and ventilation, and long presence of nasogastric tubes.3 Furthermore, TEF can be dramatic in these patients since it may potentially progress to a mediastinitis, worsening the outcomes. CASE SERIES We experienced four cases of TEF among our first 36 tracheostomized patients on V-V ECMO during the COVID-19 second wave, between October, 2020 and May, 2021 (Table 1). [Extracted from the article]

Background: Repair of large, upper thoracic, cuff-induced, tracheo-esophageal fistula (TEF) is technically demanding and is conventionally performed by open surgery. Minimal access approach is, hitherto, unreported. Technique & Case: Minimally invasive repair of TEF involving fistula isolation - by thoracoscopic oesophageal exclusion, and simultaneous establishment of alimentary continuity - by laparoscopy-assisted sub-sternal colonic transposition, is described. The technique was successfully employed in repairing a large (4.5 centimetres), cuff-induced, upper thoracic TEF, in a 25-year-old woman. The rationale behind the technique, its pros and cons are analysed and contrasted against conventional techniques of TEF repair. Conclusion: Large upper thoracic, cuff-induced TEF can be successfully repaired employing minimal access. [ABSTRACT FROM AUTHOR]

Background: Esophageal Atresia (EA) with or without associated tracheo-esophageal fistula (TEF) is one of the common congenital anomaly that can be life threatening if left unattended. In low and middle income countries like Pakistan, the management and outcome of such type of cases depends upon many factors related to resource limitation. Objective: To prospectively evaluate the management and outcome of esophageal atresia at Children Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. Study design, settings and duration: An Observational-descriptive study was conducted at the Department of Pediatric Surgery, The Children Hospital, PIMS, Islamabad from October 2017 to August 2018. Methodology: Consecutive patients diagnosed with esophageal atresia were included in the study. Demographic data, investigations, procedure performed and outcome were collected on a pre designed proforma and results were analysed. Results: Total 140 consecutive patients of esophageal atresia were enrolled in study. Out of 140 patients, 79 (56.4%) were male and 61 (43.6%) were female. Mean age at presentation of esophageal atresia was 5.5 days (ranged from 1-30 days). Mean weight was 2.43 kg. Regarding type of esophageal atresia, 10 (7.1%) patients had type A, 97 (69.3%) had type C, 1 (0.7%) had type E and 1 (0.7%) had type F esophageal atresia. Nine patients with type A underwent cervical esophagostomy along with feeding gastrostomy. Right thoracotomy was performed in 98 cases. End to end esophageal anastomosis was possible in 76 patients. Twenty one patients had long gap EA for which cervical esophagostomy and feeding gastrostomy was done. Sepsis was the main complication post operatively (29.3%) followed by pneumonia (14.3%), Anastomotic leak (7.9%) and surgical site-infection (2.1%). Overall mortality was 57.9% (81/140) with pre operative mortality of 21.4% (30/140) and post operative mortality of 36.5% (51/140). Low birth weight and post operative sepsis, anastomotic leak and pneumonia had statistically significant relationship with mortality using SPSS version 21. Conclusion: With the improvement of medical facilities, better survival rates of patients with esophageal atresia can be achieved. [ABSTRACT FROM AUTHOR]

Gastro-esophageal reflux disease (GERD) is a pathological entity in which the mixture of gastric contents (with low pH because of the high content of HCl acid) and biliary juice (rich in proteolytic enzymes like pepsin and trypsin) causes lesions on the mucosa lining the esophagus. A higher prevalence of GERD was discovered in patients who had a total laryngectomy. Concerning laryngectomies with tracheo-esophageal speaking valves, it has been demonstrated that GERD is an independent risk factor for failure of this method of speech rehabilitation. The authors performed an analysis of English language articles found following a search of the major medical scientific databases (NCBI®, EMBASE®, Cochrane®) containing the following keyword string: vocal prosthesis, total laryngectomy, GERD, acid reflux, tracheo-esophageal fistula, failure. Studies showed that exposure to the protelolytic enzymes from the reflux juice increases the diameter of the tracheo-esophageal fistula and permits local granulation tissue to form. Progressively, the increasing fistula diameter leads to complications ranging from microaspiration of liquids and saliva to speaking valve expulsion or ingestion and temporary incapacity of oral feeding. Medical therapy in the postoperative period as well as long-term (6 months or more) correction of GERD (PPI therapy, H2 blockers, prokinetics) is also demonstrated to reduce the complication rate in this category of patients. GERD has a high prevalence in the total laryngectomy population of patients and it has multiple etiologic factors. In patients with tracheoesophageal vocal prostheses, GERD causes an increase in the fistula diameter - with important consequences that affect the patient's quality of life - his ability to phonate and his ability to swallow. These complications come with added costs because of the need to more frequently change the vocal prostheses with ones increasing in diameter, as well as multiple hospitalizations (even surgery to recalibrate or close the tracheo-esophageal fistula). Recognizing and treating this condition therefore decreases the risk of complications following vocal prosthesis speech rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Tracheal stenosis is usually iatrogenic, a result of an accident or due to tracheal tumors. Anesthesia for tracheal resection and reconstruction is a challenging job and requires expertise. The crux of anesthetic management is securing the airway early and maintenance of ventilation and oxygenation during resection and reconstruction. This study is aimed to share the anesthetic management and outcome of 21 cases of tracheal resection and reconstruction surgery for tracheal stenosis. Methodology: This prospective, descriptive study was carried out at PNS Shifa Hospital Karachi and Combined Military Hospital Rawalpindi between October 2014 and July 2018. All 21 patients undergoing tracheal resection and reconstruction surgery for tracheal stenosis at these centers were enrolled. Informed consent was obtained from all patients and institutional ethics committee approval was secured. The site of tracheal stenosis, type of anesthesia used, ventilation and oxygenation before and during resection and anastomosis of trachea and the type of surgery and the outcome was noted. The data were collected in MS Excel sheet and simple statistical analysis done to present the results. Results: Out of 21 patients, 9 (43%) were males and 12 (57%) were females, between 6 to 66 years of age of ASA II-IV. Post intubation stenosis was the leading cause of stenosis followed by tumor, trauma and corrosive ingestion. Fourteen patients had high cervical / subglottic stenosis and were operated by high anterior cervical collar incision, while five had lower tracheal lesions, and 2 had carinal lesion and were operated by right thoracotomy. Seven patients were anesthetized through tracheostomy tube, one by fiberoptic intubation, and the rest with 5-7 mm ETT with or without muscle relaxant. One patient developed cardiac arrest during surgery, but was revived successfully. Four (19%) out of 21 had to be put on ventilator postoperatively while remaining 17 (89%) were extubated on operating table. Two patients on ventilator were weaned of successfully. Outcome was excellent in 19 (90%) cases while in 2 (10%) patients, operation was unsuccessful and they landed up with permanent tracheostomy. Conclusion: The study highlights the importance of prevention of post-intubation tracheal stenosis with strict vigilance and high quality professional nursing care. Thorough preoperative assessment and preparation, intra operative management, a backup plan and close communication between the surgeon and anesthesiologist are necessary for successful outcome. Most of these patients require general anesthesia and profound relaxation. [ABSTRACT FROM AUTHOR]

The value of laryngotracheobronchoscopy (LTB) immediately prior to repair of esophageal atresia with or without tracheo-esophageal fistula is contentious. Currently, there is a wide range of opinion on the utility of this investigation which is reflected by huge variation in clinical practice. This review is a critical analysis of the arguments for and against performing routine LTB prior to esophageal atresia repair. Reserving LTB for selected cases only is potentially disadvantageous since it limits the surgeon's and anesthetist's familiarity with the procedure, equipment, and range of potential findings. There is sufficient evidence to suggest that routine preoperative LTB becomes the standard of care. [ABSTRACT FROM AUTHOR]

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Background: Transanastomotic feeding tube (TAFT) is commonly used for post-operative enteral nutrition after esophageal atresia (EA)/tracheoesophageal fistula (TEF) repairs. The purpose of this study is to analyze the therapeutic implications of avoiding a TAFT and its impact on the outcomes post-operatively. Methods: The medical data of 33 inpatients with EA/TEF type C repair from 2009 to 2014 were retrospectively reviewed. Patients were divided into two groups for comparison based on the usage of TAFT during the repair: TAFT- (without) and TAFT+ (with) groups, without randomization. Both groups were compared statistically for post-operative complications and outcomes. Results: Eighteen neonates were males and 15 females, with an average birth weight of 2.43±0.43 kg and a mean gestational age of 36.15 weeks. Nineteen (57.5%) in the TAFT- group and 14 (42.4%) were in the TAFT+ group. The post-operative complications, need for dilatations, duration of total parenteral nutrition (TPN) and length of hospital stay were similar in both groups. The incidence of pneumonitis was significantly higher in the TAFT+ group. Conclusions: By avoiding a TAFT, there is no increase in complication rates nor does it entail a prolonged period of TPN. Besides, not using a TAFT may have the advantage of reducing incidence of aspiration and consequent pneumonitis. [ABSTRACT FROM AUTHOR]

Background: Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung.Objective: To describe the imaging features in five children with esophageal bronchus.Materials and Methods: We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler.Results: Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF.Conclusion: Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy. [ABSTRACT FROM AUTHOR]

Tracheo-esophageal fistula (TEF) without associated esophageal atresia or H-type fistula is a rare congenital anomaly. H-type fistula is usually missed in the neonatal period as the presenting symptoms are either of recurrent pneumonia or gastro-esophageal reflux which always lead to delay in diagnosis and infant undergoes unnecessary treatment. We report a case of H-type of TEF, diagnosed within 12 days of birth based upon choking and cyanosis on the first trial of spoon feeds. Diagnosis was confirmed with contrast esophagogram. The infant was operated for it and was successfully discharged. [ABSTRACT FROM AUTHOR]

The first thoracoscopic esophageal atresia with tracheo-esophageal fistula (EATEF) repair was performed in March of 2000. This report evaluates the results and evolution of the technique over the last decade. Thoracoscopic esophageal atresia repair has proven to be an effective and safe technique. Initial experience resulted in a higher stricture rate but this improved with experience and changes in technique over the last decade. The outcomes are similar to or superior to that of an open thoracotomy and avoid the musculoskeletal morbidity associated with that technique. [ABSTRACT FROM AUTHOR]

Esophageal Atresia (EA) is a severe developmental defect of the foregut that presents with or without a Tracheo-Esophageal Fistula (TEF). The prevalence of EA/TEF over time and around the world has been relatively stable. EA/TEF is manifested in a broad spectrum of anomalies: in some patients it manifests as an isolated atresia or fistula, but in over half it affects several organ systems. While the associated malformations are often those of the VACTERL spectrum (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal and Limb), many patients are affected by other malformations, such as microcephaly, micrognathia, pyloric stenosis, duodenal atresia, a single umbilical artery, and anomalies of the genitourinary, respiratory and gastrointestinal systems. Though EA/TEF is a genetically heterogeneous condition, recurrent genes and loci are sometimes affected. Tracheo-Esophageal (TE) defects are in fact a variable feature in several known single gene disorders and in patients with specific recurrent Copy Number Variations and structural chromosomal aberrations. At present, a causal genetic aberration can be identified in 11-12% of patients. In most, EA/TEF is a sporadic finding; the familial recurrence rate is low (1%). As this suggests that epigenetic and environmental factors also contribute to the disease, non-syndromic EA/TEF is generally believed to be a multifactorial condition. Several population-based studies and case reports describe a wide range of associated risks, including age, diabetes, drug use, herbicides, smoking and fetal alcohol exposure. The phenotypical and genetic heterogeneity seen in EA/TEF patients indicates not one underlying cause, but several. Unraveling the complex multifactorial and heterogeneous etiology of EA/TEF and associated features will require large cohorts of patients. Combined statistical analysis of component findings, genome sequencing, and genome wide association studies will elucidate new causal genetic defects and predisposing loci in the etiology within specific sub-populations. Improved knowledge of environmental risk factors, genetic predisposition and causal genetic syndromes may improve prediction and parental counseling, and prevent co-morbidity. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Aim of this systematic review is to investigate the thoracic and cervical surgical approaches of H-type tracheo-esophageal fistula (TEF) according to the position of the fistula. Methods: The PubMed database was searched for original studies on H-type TEF treatment published between 1977 and 2012. Manuscripts finally included were divided into open and thoracoscopic surgery groups. Results: Seventeen studies were selected for open surgery group, and most of them agree on the importance of pre-operative diagnosis of the fistula by preliminary tracheoscopy. Right cervicotomy was used in 70 cases (76.9%), left cervicotomy in 12 (13.2%), and thoracotomy only in 9 (9.9%). Five studies were included in thoracoscopic group (6 patients). Indications for the surgical approach (cervical vs thoracic) according to the position of the TEF were clearly described in 10 manuscripts, and all stated differences in surgical technique details. Complications and mortality rates were not statistically correlated to the different surgical approaches. Conclusions: The evidence base in regard to the treatment of H-type fistula in children is poor and the skills and preferences of the surgeons guide the choice of the procedure. Surgical division of the fistula is curative, and the key to a successful repair is the pre-operatively identification of the level of the fistula with tracheoscopy. Right cervicotomy seems to be the approach of choice in the majority of case, with the thoracic approach appropriate only for fistulae opening below T2. Further well-designed prospective studies which take into account of selection and performance bias are strongly required. [Copyright &y& Elsevier]

Communicating bronchopulmonary foregut malformations are a diverse group of congenital anomalies characterized by a fistula between the respiratory and alimentary systems. Among these malformations, the association of an esophageal lung with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) is extremely rare. We report the case of a neonate with esophageal lung detected following the primary repair of EA with TEF. Despite the rarity of esophageal lung with EA and TEF, it should be considered to develop in infants with abnormal findings on chest radiographs and an unusual preoperative and/or in the postoperative clinical course of EA and TEF. Swallowing study with water-soluble contrast medium is the investigation of choice to demonstrate the anatomic connection, if EA and TEF were already primarily repaired. If not, although the use of preoperative CT may be debatable in neonates due to the associated radiation exposure, in selected cases such as our patient, preoperative CT can be useful for early preoperative diagnosis. [ABSTRACT FROM AUTHOR]

Esophageal atresia and tracheo-esophageal fistula are severe congenital malformations, whose etiology is still poorly understood. So far, numerous genetic and environmental factors that may contribute to the occurrence of these defects have been described and the literature is dominated by the view of their common involvement in the etiology and pathogenesis of congenital esophageal atresia. In this review the authors present current knowledge on the embryogenesis of the esophagus and trachea, discuss environmental risk factors, and also list and describe genetic alterations identified so far in patients with congenital esophageal atresia. [ABSTRACT FROM AUTHOR]

Background: Primary surgical repair forms the definitive treatment of esophageal atresia. Long-term survival rates and patient morbidity after repair still remains a problem especially in developing countries. Postoperative morbidity depends on the incidence of anastomotic leak, gastroesophageal reflux, strictures, and recurrent fistula formation. Purpose: To describe the frequency of different findings at fluoroscopic evaluation of postoperative esophagus in children following repair for esophageal atresia with or without tracheo-esophageal fistula. Material and Methods: Hospital records and upper gastrointestinal contrast studies of 210 patients following repair for esophageal atresia with or without a tracheo-esophageal fistula were reviewed by two pediatric radiologists. All children underwent surgery in the first few days of life (days 1–6). Fluoroscopic contrast study was performed at various intervals after surgery in children with suspected complications or feeding difficulties. Results: Images from upper gastrointestinal contrast studies of 210 patients (126 boys, 84 girls) were evaluated and recorded. Findings were recorded as normal postoperative appearances (37.1%) and complications/sequelae, which included strictures (33.8%), minor and major leaks (11.9%), reflux (13.8%), motility problems (7.1%), persistent fistula (3.8%), diverticulae formation (4.7%), and hiatus hernia (2.1%). Conclusion: Strictures, leaks, and reflux are the most common complications of esophageal atresia repair. Knowledge of various postoperative appearances would be useful for planning an appropriate management strategy in these children. [ABSTRACT FROM AUTHOR]

Purpose Esophageal atresia and tracheo-esophageal fistula (EA-TEF) result from abnormal division of the foregut into esophagus and trachea thus, it may influence airway branching and lung development. The present study examined lung morphogenesis in fetuses with EA-TEF focusing in the expression of FGF10 and its receptor FGFR2 IIIb. Methods Pregnant rats received either 1.75 mg/kg i.p. adriamycin or vehicle on E7, E8 and E9. Embryos were recovered at E15, E18 and E21 and lungs processed for immunohistochemistry and RT-PCR. Three groups were studied: control, adriamycin-exposed with EA-TEF, and adriamycin-exposed without EA-TEF. Comparisons were performed with Mann–Whitney or t tests (significance level, 5 %). Results Lung weight at E15 and E18 were significantly lower in adriaEA fetuses in which the relative mRNA levels of FGF10 were significantly higher. These differences disappeared near term. The receptor FGFR2 IIIb messenger was only significantly increased in adria noEA fetuses at E15. Immunohistochemical study was consistent with these findings. Conclusions Abnormal expression of FGF10 during earlier stages of development, when the lungs are smaller than controls, suggests a compensatory response aimed at ‘‘catching up’’ delayed tracheobronchial branching. Whether similar changes take place in the human condition and influence respiratory physiology remain to be determined. [ABSTRACT FROM AUTHOR]

Background: VATER association was first described in 1972 by Quan and Smith as an acronym which identifies a non-random co-occurrence of Vertebral anomalies, Anal atresia, Tracheoesophageal fistula and/or Esophageal atresia, Radial dysplasia. It is even possible to find out Cardiovascular, Renal and Limb anomalies and the acronym VACTERL was adopted, also, embodying Vascular, as single umbilical artery, and external genitalia anomalies. Methods: Data on patients with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) admitted in the Neonatal Intensive Care Unit (NICU) between January 2003 and January 2013 were evaluated for the contingent occurrence of typical VACTERL anomalies (VACTERL-type) and non tipical VACTERL anomalies (non- VACTERL-type). The inclusion criterion was the presence of EA with or without TEF plus two or more of the following additional malformations: vertebral defects, anal atresia, cardiovascular defects, renal anomalies and lower limb deformities, like radial dysplasia. Results: Among 52 patients with EA/TEF, 20 (38,4%) had isolated EA and 7 (21,8%) had a recognized etiology such a syndrome and therefore were excluded. Among 32 infants with EA and associated malformations, 15 (46,8%) had VACTERL association. The most common anomalies were congenital heart defects (73,3%), followed by vertebral anomalies (66,6%). Many patients also had additional non-VACTERL-type defects. Single umbilical artery was the most common one followed by nervous system abnormalities and anomalies of toes. Between the groups of infants with VACTERL type and non-VACTERL-type anomalies, there are several overlapping data regarding both the tipically described spectrum and the most frequently reported non-VACTERL-type malformations. Thus, it is possible to differentiate infants with a full phenotype (VACTERL full phenotype) and patients that do not meet all the criteria mentioned above, but with some homologies with the first group (VACTERL partial phenotype). Conclusion: The high frequency of non-VACTERL-type anomalies encountered in full and partial phenotype patients would suggest the need for an extension of the clinical criteria for the diagnosis of VACTERL association and also for pre- and post-operative management and follow-up in the short and long term. [ABSTRACT FROM AUTHOR]

An ingested foreign body lodged in the esophagus is common in children. Button batteries impacted in the esophagus need early diagnosis and intervention to avoid complication. We report a case of neglected button battery impacted in the upper esophagus in a 15-month-old female child. The problems encountered during the course of management have been discussed along with the review of the literature. Button battery ingestions in children need to be considered as an emergency and prompt endoscopic removal should be advocated. Rigid esophagoscopy is the gold standard technique of removing esophageal foreign bodies. Complication must be anticipated and managed at the earliest. [ABSTRACT FROM AUTHOR]

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. [ABSTRACT FROM AUTHOR]

Background/Aim Patients with esophageal atresia and tracheo-esophageal fistula (EA-TEF) have chronic respiratory tract disease and deficient tracheal innervation. This study tests the hypothesis in rats with EA-TEF that deficient lung innervation could be one of the causes of respiratory disease.Material and Methods Pregnant rats were treated with either 2 mg/kg i.p. adriamycin or vehicle on E7, E8 and E9. Lungs and tracheas were retrieved on E15, E18 and E21 (term: E22). Innervation was examined by regular (PGP 9.5 and GDNF) and whole-mount (PGP 9.5 and α-actin) immunohistochemistry. PGP 9.5 and GDNF mRNA were measured by real-time, quantitative RT-PCR and the levels of PGP 9.5 protein by immunoblot. Embryonic lung primordia harvested on E13 were cultured for 72 h and airway peristalsis was assessed under an inverted microscope. PGP 9.5 expression was then examined in explants by whole-mount immunohistochemistry and RT-PCR. Values were compared with non-parametric tests.Results Neural networks were present in both EA-TEF and control fetuses on E15, E18 and E21, but the neural network was obviously disorganized in whole-mount immunohistochemistry of EA-TEF. The pan-neural marker PGP 9.5 protein was increased at term whereas the neural chemo-attractant GDNF protein was unchanged. PGP 9.5 mRNA significantly increased from subnormal levels on E15 to very increased ones on E18 compared with controls. GDNF mRNA levels followed the same trend. Airway peristalsis of explanted embryonal lungs was similar in both groups. The neural networks were underdeveloped in these primordia, as assessed by whole-mount PGP 9.5 immunohistochemistry and RT-PCR.Conclusions The development of respiratory tract innervation in adriamycin-induced EA-TEF was delayed and abnormally controlled in rats compared with controls. However, these deficiencies were apparently compensated for at term and had no effect on airway peristalsis. The possible significance of innervation anomalies for respiratory sequelae in EA-TEF patients deserves further investigation. [ABSTRACT FROM AUTHOR]

Congenital Tracheo-esophageal fistula is an abnormal communication between the trachea and the esophagus with or without esophageal atresia. The reported incidence of trachea-esophageal fistula is 1 in every 2000-4000 births. It is frequently associated with other congenital anomalies of the heart, lung, kidney, gastrointestinal tract and as part of VATER association (V: Vertebral; A: Anal; TE: Tracheo-Esophageal; R: Renal) or the VACTERL association (VATER + C: Cardiac; and L: Limb). Our patient was a preterm, low birth weight neonate with multiple congenital malformations like hypoplasia of the right lung and right pulmonary artery, dextroposition of the heart, patent ductus arteriosus and atrial septal defect. Interestingly, despite a normally draining right pulmonary vein, his chest X-ray showed "Scimitar sign". On extensive Medline search, we could not find any reports of anaesthetic management of such patients coming for primary corrective surgery. [ABSTRACT FROM AUTHOR]

Background/Purpose: During repair of esophageal atresia with distal tracheo-esophageal fistula, air leakage through the fistula during mechanical ventilation can cause respiratory demise. Methods: From February 2012 until November 2014, all patients with esophageal atresia and distal tracheo-esophageal fistula were subjected to preoperative tracheobronchoscopy. Relatively distal fistulas were cannulated with a Fogarty catheter and blocked by insufflation (video illustration). Relatively proximal distal fistulas were sealed by precise placement of a cuffed ventilation tube. Results: Nine of 12 patients received Fogarty balloon placement. The fistula of the remaining 3 patients were sealed by careful tube placement. No complications related to tracheobronchoscopy or Fogarty placement were noted. All procedures were uneventful. Conclusions: Preoperative tracheobronchoscopy to evaluate the usefulness of Fogarty balloon insertion or correct tube placement for distal tracheo-esophageal fistula is a safe and easy to perform procedure that can avoid complications in type C esophageal atresia repair. [ABSTRACT FROM AUTHOR]

Congenital esophageal stenosis (CES) is a rare congenital abnormality that is difficult to diagnose and often masquerades as other types of structural esophageal disease. We report three cases of CES with different presenting symptoms. We advocate for balloon dilation as the preferred first approach to therapeutic intervention. CES is an important clinical entity in the evaluation of pediatric esophageal disorders and should be suspected in young infants with dysphagia. [ABSTRACT FROM AUTHOR]

Abstract: Esophageal atresia with/without tracheo-esophageal fistula is a relatively common malformation, occurring in around 1 in 3500 births. In around half of cases, additional malformations are present, forming either a syndrome of known genetic aetiology, or a recognised association, of which the VACTERL association (Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal and Limb malformations) is the most recognised. Recently, microdeletions of the FOX gene cluster at 16q24.1, comprising four genes, FOXF1, MTHFSD, FOXC2 and FOXL1, were reported to cause a phenotype resembling VACTERL association, with vertebral anomalies, gastro-intestinal atresias (esophageal, duodenal and anal), congenital heart malformations, and urinary tract malformations, as well as a rare lethal developmental anomaly of the lung, alveolar capillary dysplasia. This article reviews these new data alongside other genetic causes of syndromic esophageal atresia, and also highlights information from relevant mouse models, particularly those for genes in the Sonic Hedgehog pathway. [Copyright &y& Elsevier]

Abstract: Only eight cases involving deletions of chromosome 17 in the region q22–q24 have been reported previously. We describe an additional case, a 7-year-old boy with profound mental retardation, severe microcephaly, facial dysmorphism, symphalangism, contractures of large joints, hyperopia, strabismus, bilateral conductive hearing loss, genital abnormality, psoriasis vulgaris and tracheo-esophageal fistula. Analysis with whole-genome SNP genotyping assay detected a 5.9Mb deletion in chromosome band 17q22–q23.2 with breakpoints between 48,200,000–48,300,000bp and 54,200,000–54,300,000bp (according to NCBI 36). The aberration was confirmed by real-time quantitative PCR analysis. Haploinsufficiency of NOG gene has been implicated in the development of conductive hearing loss, skeletal anomalies including symphalangism, contractures of joints, and hyperopia in our patient and may also contribute to the development of tracheo-esophageal fistula and/or esophageal atresia. [Copyright &y& Elsevier]

CHARGE association and DiGeorge syndrome (DGS) rarely occur together and only eight cases have been reported in the English literature. Two were associated with esophageal atresia (EA) and severe congenital heart anomalies. We report a third case of EA with tracheoesophageal fistula (EA-TEF) associated with coarctation of the aorta (CoA), CHARGE association, and DGS. The challenge for management in this complicated case is the background DGS which influences surgical outcome because of Ca++ imbalance and immune deficiency that can be life-threatening and require bone marrow transplantation. [ABSTRACT FROM AUTHOR]

Background Anaplastic kinase-1 positive lymphoma (ALK-1) is a very rare but distinct pathologic entity. ALK-1 lymphoma tends to affect the bone marrow, skin, lungs, soft tissue, but very rarely the gastrointestinal tract. Methods We report a case of ALK-1 positive lymphoma presenting as a tracheoesophageal fistula. The clinical presentation, histopathology, and management outcome are all discussed. Conclusion ALK-1 positive lymphoma of the upper aerodigestive involvement is extremely rare. An unusual presentation such as pharyngeal pouch with vocal cord palsy should suggest pathology. Histopathologic analysis can be difficult and immunohistochemical studies will aid are of paramount importance in the diagnosis and help in subsequent management and also act as prognostic indicators. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Introduction: Initial management of wide-gap esophageal atresia and tracheo-esophageal fistula, especially in developing countries, often involves ligation of the fistula, proximal esophagostomy and a gastrostomy. The conventional gastrostomy requires an abdominal incision and has several complications. The authors present an alternative technique of 'gastrostomy' that does not require an abdominal incision.Method: Through a standard right thoracotomy, the fistula is divided and tracheal end closed. If primary anastomosis is not possible due to wide gap, the lower esophageal pouch is mobilised and brought out as a stoma on the left posterior chest wall, lateral to the paraspinal muscles in the 7th or 8th intercostal space. A feeding tube is passed through the stoma into the stomach. The thorax is closed with a drain. Proximal esophagostomy is performed in the neck. The thoracic stoma is intermittently intubated for feeding until the child is ready for gastric transposition.Results: The technique was successfully used in 5 patients. Feeding through the stoma could be established in 4. One patient had stomal retraction and died of resultant sepsis. One patient has subsequently undergone gastric transposition and one more is waiting for it. Two patients died of unrelated causes before esophageal replacement could be carried out.Discussion: This is an alternative technique for feeding 'gastrostomy'. We have named the procedure as "Thoracic Gastrostomy" because the stoma is located on the chest but functions as a gastrostomy. The advantages include avoidance of a laparotomy and its complications, easy feeding by intermittent intubation, and availability of a virgin stomach for future gastric transposition. [ABSTRACT FROM AUTHOR]

Percutaneous tracheostomy is more and more used in the intensive care units. However, it’s not devoid of risks. We report the case of a patient who developed a tracheo-esophageal fistula discovered after removal of the cannula 23 days after tracheotomy. During the procedure, difficulties occurred during the insertion of the cannula. This case report reminds the importance of a peroperative continuous endoscopic guidance and the need of a rigorous learning. [Copyright &y& Elsevier]

Laparoscopic and open thoracic surgery in the neonate typically results in hypercapnea and low cardiac output with often poor surgical visualization as the anesthesiologist attempts to correct the respiratory derangements usually seen. We describe three cases in which jet ventilation provided not only superior ventilation with a return to normocapnea but also ideal operating conditions. In addition, jet ventilation utilizes lower mean airway pressures which typically results in improved cardiac output. [ABSTRACT FROM AUTHOR]

Objective: To evaluate general health condition of children operated for esophageal atresia, including complications from gastrointestinal tract and skeletal defects. Methods: Between 1990 and 2005, 77 patients were operated for esophageal atresia in the Polish Mother's Health Memorial Hospital. The study was based on retrospective analysis of medical case records of all children with esophageal atresia. All living patients ( n=51) were invited for follow-up studies. Results: Pathological gastroesophageal reflux was found in 46.7% of children. Scoliosis was diagnosed in 20 patients. Chest deformations were observed in 43.3% children Conclusion: The absence of clinical symptoms does not exclude the presence of gastroesophageal reflux in children operated for esophageal atresia. Children operated for esophageal atresia should be followed up regularly by a multispecialistic medical team. [ABSTRACT FROM AUTHOR]

This report describes a successful outcome in a preterm baby with an esophageal atresia and tracheo-esophageal fistula, who initially underwent a primary esophageal repair; but a persistent nonexpanding lung on the side of surgery led to further investigations. A further diagnosis of an esophageal lung resulted in pneumonectomy and prophylactic placement of an intra-thoracic prosthesis to prevent post-pneumonectomy syndrome. To the best of our knowledge, this is the first report of a prophylactic placement of an intra-thoracic prosthesis in a neonate with the condition of esophageal atresia and tracheo-esophageal fistula and associated esophageal lung. [ABSTRACT FROM AUTHOR]

Certain categories of foreign bodys ingestion in children can cause dangerous and severe complications leading to increased morbidity rates among them. We report a case of disk battery ingestion in a 2 year old girl, with impaction in the upper cervical esophagus, extracted in otolaryngology service but complicated afterwards with tracheo-oesophageal fistula and aspiration pneumonia and by long-term effect with high esophageal stenosis that required endoscopic dilatation. [ABSTRACT FROM AUTHOR]

This paper reports the case of a male term-newborn, without problems during gestation process who died at birth and who was detected in autopsy with: upper third esophageal atresia, tracheo-esophageal fistula, tracheal atresia and arterious duct persistence. Esophageal atresia with tracheoesophageal fistula is a disorder affecting 1 per 5,000 births. This disease associated to tracheal atresia is even less common. Bibliography does not report more than 100 cases of these. Its early detection may increase life probabilities. [ABSTRACT FROM AUTHOR]

Purpose: The management of the esophageal atresia and tracheo-esophageal fistula (EA/TEF) with right-sided aortic arch (RAA) is controversial. The preoperative diagnostic techniques may fail to show RAA associated with EA/TEF. Surgeon may need to make a decision to change the side of thoracotomy. The aim of the current study was to evaluate the possibility of preoperative diagnosis of RAA and the primary anastomosis through right chest.Methods: A retrospective review was performed in EA/TEF patients between February 2001 and 2008. A total of 79 patients (35 female, 44 male) with EA/TEF were reviewed. Eleven (13%) patients (5 female, 6 male) had an RAA. Echocardiography was performed in 10 of 11 patients with RAA. The chest was accessed through the right side in all patients.Results: The incidence of RAA was found to be higher in our study than previous studies (13%). Right thoracotomy was performed successfully in all patients. Three patients died due to multiple congenital anomalies and 1 patient due to bleeding postoperatively. Five of 10 had normal echocardiography findings. Only one patient with RAA has been successfully diagnosed by preoperative echocardiographic examination. Seven patients had no complication after operation. Their follow-up was uneventful.Conclusion: Preoperative recognition of RAA with echocardiography is unlikely in patients with EA/TEF but the presence of RAA does not decrease the success rate of EA/TEF repair through the right thoracotomy. [ABSTRACT FROM AUTHOR]

A majority of the cases of acquired tracheo-esophageal fistula (TEF) are a result of complication of malignancy. Acquired non-malignant TEFs result from a variety of causes. Among these causes, the most common is iatrogenic that results from prolonged tracheal intubation. Denture impaction of the esophagus resulting in the development of an acquired TEF is rare. Whatever be the cause, the diagnosis of a TEF is a surgical emergency because delay in treatment can result in devastating pulmonary complications from aspiration through the TEF. Surgical treatment of non-malignant TEFs usually gives good results. An unusual case of non-resolving pneumonia resulting from recurrent aspiration through an acquired TEF caused by an accidentally swallowed denture is reported here. Patient's pneumonia resolved completely following the surgical correction of the fistula. [ABSTRACT FROM AUTHOR]

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. [ABSTRACT FROM AUTHOR]