Abstract
Recurrent tracheoesophageal fistula (TEF) is still difficult to diagnose and repair. In almost all cases, recurrence appears relatively soon after the primary surgery. We herein describe a case of recurrent TEF that appeared 10 years after the primary repair. At 2 years of age, the patient suffered from mental retardation due to encephalitis and developed a hiatus hernia with gastro-esophageal reflux. He underwent the repair of a hiatus hernia and fundoplication at 3 years of age. However, the hiatus hernia recurred 6 months after the operation. The patient suffered from recurrent pneumonia for 6 years after the appearance of the recurrent hiatus hernia. At 9 years of age, he was hospitalized frequently due to recurrent severe pneumonia. After admission at 9 years of age, an endoscopic study under general anesthesia was performed and revealed subglottic stenosis and a dilated esophagus with a recurrent hiatus hernia. Tracheotomy or laryngotracheal separation was first planned in order to improve his upper airway and facilitate the safer repair of the recurrent hiatus hernia. After laryngotracheal separation, the patient still suffered from severe pneumonia. In addition, a small volume of nutritional supplement was aspirated from the tracheostomy. Thus, recurrent TEF was suspected. Tests using dye under both esophagoscopy and bronchoscopy confirmed recurrent TEF. The fistula recurred in the cervical area because of the elevation of the esophagus due to the recurrent hiatus hernia. The fistula was surgically closed, with a sternothyroid muscle flap to prevent re-recurrence. At 4 months after this operation, the recurrent hiatus hernia was repaired. Thereafter, the patient’s respiratory symptoms showed a dramatic improvement. The patient is now doing well and free from further recurrences of TEF and hiatus hernia at 2 years after the final operation.
Highlights
Previous studies involving large series of patients have revealed that recurrent tracheoesophageal fistulas (TEFs) occur in 6–16 % of patients who undergo esophageal atresia (EA)/TEF repair, typically in the first year of life [1,2,3,4,5,6,7,8].Various factors are implicated in the formation of recurrent TEFs
In summary, we described a case of recurrent TEF that was found 10 years after the initial surgery
The recurrent fistula was located in the cervical area, which was an unusual area for a TEF to recur
Summary
Previous studies involving large series of patients have revealed that recurrent tracheoesophageal fistulas (TEFs) occur in 6–16 % of patients who undergo esophageal atresia (EA)/TEF repair, typically in the first year of life [1,2,3,4,5,6,7,8]. Thereafter, a diagnosis of TEF was made, and gastrostomy was created in the previous hospital He was transferred to our institution at 28 days of age. He was diagnosed as having an EA with a distal TEF (Gross C), and the primary repair of the EA with fistula division was performed at our hospital when he was 5 months of age. A reoperation to repair the herniation was not performed because the patient had been in stable condition He had been suffering from recurrent respiratory tract infections since he was 7 years of age. We thought that we should perform tracheotomy or laryngotracheal separation before repairing the recurrent hiatus hernia because the patient presented with severe dysphagia as well as severe hiatus hernia. The patient remains well at 2 years after the surgical repair of
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