Abstract
A congenital tracheo-esophageal fistula of the H-type is a rare variant. The diagnosis is usually missed because of mild symptoms. A long history of coughing during liquid intake and nocturnal cough may aid in the diagnosis. A delay in the diagnosis may have a deleterious effect on the lung because of recurrent infections. Surgery is the cornerstone of management. Self-expandable metallic stents (SEMS) do not have a role in the management of these fistulae. We report a case of a missed diagnosis of a congenital H-type fistula managed as an acquired tracheo-esophageal fistula with two attempts at conservative management with a tracheal self-expandable metallic stent. The difficulties and disadvantages of using self-expandable metallic stents for the management of benign tracheo-esophageal fistulae are also discussed.
Highlights
Tracheo-esophageal fistula in adults is classified as either malignant or benign [1]
The majority of congenital tracheo-esophageal fistulae are detected at neonatal age because of esophageal atresia
We describe a patient with a congenital H-type tracheo-esophageal fistula who was misdiagnosed earlier as an acquired one and was managed with a self-expandable metallic tracheal stent elsewhere
Summary
Tracheo-esophageal fistula in adults is classified as either malignant or benign [1]. We describe a patient with a congenital H-type tracheo-esophageal fistula who was misdiagnosed earlier as an acquired one and was managed with a self-expandable metallic tracheal stent elsewhere. This case demonstrates the critical role of a thorough clinical history in etiological diagnosis as well as the technical difficulties posed by a previous tracheal SEMS during surgical repair of a tracheo-esophageal fistula. A 57-year-old male with no known medical conditions was referred to us for surgical management following the failure of endotherapy with a self-expandable metallic tracheal stent for an acquired tracheo-esophageal fistula He had no previous history of cancer or surgical intervention.
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