Abstract
Four cases of H-type tracheoesophageal fistula are reported. The patients all had chronic aspiration from the esophagus. Although serious symptoms were present in all, definitive diagnoses were not made until the patients had reached 1, 6, 12, and 50 years of age, because ordinary radiologic methods failed to establish the diagnosis. The angulation of the fistula usually prevents contrast medium in the esophagus from entering the trachea, especially with the subject upright. On the other hand, air easily passes from the trachea to the esophagus, eventually producing megaesophagus which may be confused with the picture of achalasia. An ill-advised Heller esophagomyotomy was done on 1 patient. All 4 patients eventually had successful closure of the fistulas. Three operations were by the transthoracic route, and 1 high fistula in an infant was closed through a cervical approach.
Résumé
Présentation de 4 cas de fistule trachéo-oesophagienne en H. Les 4 malades présentaient des symptomes d'aspiration du contenu oesophagien vers l'arbre respiratoire. Ces symptomes étaient graves dans tous les cas et pourtant le diagnostic n'a été posé qu'aux âges de 1, 6, 12 et 50 ans, parce que les examens radiologiques standard n'avaient pu mettre la lésion en évidence. L'angulation de la fistule empêche, en général, le produit opaque de passer d l'oesophage vers la trachée, surtout en position debout. Par contre, l'air passe aisément de la trachée vers l'oesophage, pouvant donner un aspect de mégaoesophage qui peut être pris pour une achalasie. Chez 1 malade, une oesophagomyotomie de Heller fut réalisée par erreur. Chez les 4 patients, la fistule a pu être fermée avec succès. L'opération a été faite par voie thoracique dans 3 cas; chez 1 enfant, la fistule haut située a été fermée par voie cervicale.
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Lam, C.R. Diagnosis and surgical treatment of “H-Type” tracheoesophageal fistulas. World J. Surg. 3, 651–656 (1979). https://doi.org/10.1007/BF01654780
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DOI: https://doi.org/10.1007/BF01654780