Tracheo-oesophageal Fistula

Tracheo-oesophageal Fistula

The tracheoesophageal fistula connects the trachea to the esophagus, causing symptoms such as coughing fits and food aspiration. The phenomenon is usually congenital and in this case is usually associated with a malformation of the trachea and esophagus. The treatment is surgical.

What is a tracheo-oesophageal fistula?

Fistulas are tubular connections between hollow organs or the body surface and an organ. These junctions correspond to pathologic ducts surrounded or lined by tissue. In principle, fistulas can form at a wide variety of locations. For slang hemangioblastoma, please visit electronicsencyclopedia.com.

The tracheoesophageal fistula corresponds to a fistula connection between the trachea and the esophagus, i.e. between the windpipe and the esophagus. Fistulous connections between these two structures can be congenital or acquired. Depending on the anatomical course, medicine distinguishes between different forms of tracheoesophageal fistula.

One of these is the tracheo-esophageal fistula at the blind sac of esophageal atresia, leading into the trachea and causing constant choking. H-fistulas, on the other hand, are connections between the esophagus and trachea that do not impair the passage of the esophagus.

Depending on the size, this congenital fistula leads at best to aspiration of liquid when drinking: A tracheoesophageal fistula of the tracheal system, which leads into the lower blind sac of esophageal atresia, is usually associated with reflux of the gastric contents and usually causes the most serious symptoms.

Causes

Like all other fistula connections, fistulas between the esophagus and trachea often occur after surgical complications. The infiltrative growth of malignant tumors can also be involved in the development. Basically, acquired fistulas between the esophagus and trachea are a rather rare phenomenon.

In less than one percent of those affected, a previous tracheostomy is the cause of fistula formation. In about five percent of cases, the formation of a fistula is preceded by malignant esophageal tumors. Less than one percent of patients suffer from primary lung tumors. The causes mentioned so far relate exclusively to the acquired form of the tracheoesophageal fistula. Depending on the cause, the acquired forms show a clinically diverse symptom picture.

In the vast majority of all cases, tracheoesophageal fistulas are congenital. Such congenital anomalies are usually associated with malformations of the esophagus or trachea and rarely occur as isolated phenomena. A congenital fistula between the esophagus and trachea occurs in about one or two newborns in every 2,000 to 4,000 live births.

The additional malformations affect up to 70 percent of patients. In the context of superordinate syndromes, the fistulas are, for example, in the context of Feingold syndrome or beta-blocker embryopathy.

Symptoms, Ailments & Signs

Patients with a tracheoesophageal fistula show different symptoms depending on the location and cause of the fistula formation. In the case of causes such as esophageal atresia, the clinical symptoms are determined by the atresia. If the fistula tract corresponds to an isolated fistula, the main symptoms are coughing attacks, which are associated with chronically recurrent aspiration pneumonia and meteorism.

The patients therefore suffer from inflammatory reactions in the lungs, since the contents of the stomach reach the lungs via their trachea. In addition, those affected often show high amounts of air in the digestive tract because the connection between the esophagus and trachea makes it easier to swallow air.

In addition to these symptoms, the fistulous tracts between the two anatomical structures can also manifest themselves in refusal to drink and blue discoloration during an attempt to drink. In addition to recurrent aspiration of liquid and food, upper lobe atelectasis can occur.

Diagnosis & course of disease

Diagnosis of a tracheoesophageal fistula is based on imaging. In the case of congenital fistulas in this location, the doctor usually arranges for imaging to indicate a refusal to drink or constant fits of coughing. H fistulas are localized from the trachea, especially from the level of C6 to C2.

These types of fistulas are therefore significantly higher than fistulas of esophageal atresia. In all cases, the detection is made by means of X-rays, which are carried out under fluoroscopy with the administration of contrast medium. The exact localization determines the classification into one of the subtypes. The prognosis of patients with tracheoesophageal fistulas depends on the precise location of the fistula and the primary cause of the duct formation.

Complications

First and foremost, those affected by this disease suffer from a very strong and, above all, unpleasant cough. This leads to coughing attacks, which can significantly restrict the everyday life of the person concerned. Inflammation and infections in the lungs also occur and have a negative effect on the patient’s quality of life.

Many sufferers choke, so that the air gets into the digestive tract. This leads to bloating and flatulence. In the worst case, aspiration can also lead to the death of the patient. Swallowing it can be fatal, especially in children. Since this disease does not heal itself, patients are always dependent on treatment by a doctor.

The treatment can usually be carried out by surgery. This takes place without complications and relieves the symptoms enormously. There are no further complaints. Inflammation and infections are treated with medication. As a rule, successful treatment does not reduce the patient’s life expectancy. However, surgical treatment only takes place once the inflammation has been treated.

When should you go to the doctor?

In the case of repeated coughing attacks or an increase in coughing, the cause should be clarified. These are warning signals from the organism, the cause of which should be determined. If food keeps getting into the trachea, if the affected person frequently chokes or if involuntary vomiting occurs, a medical examination is required.

Refusal to eat and drink fluids are considered to be of concern. A doctor must be consulted as it can lead to a life-threatening condition. An increased body temperature, inner restlessness and irritability indicate a health impairment. If you experience wheezing, problems breathing, or anxiety, see a doctor.

Disorders of the digestive tract, flatulence or swelling in the abdomen are further signs of an existing illness. If the person concerned suffers from choking, a decrease in physical resilience and sleep disorders, extensive medical examinations should be initiated.

Medical care is indicated so that there is no further impairment of the quality of life. In acute situations there is danger to life. Therefore, an emergency service must be alerted if shortness of breath, a state of unconsciousness or a panic attack occurs. Those affected are threatened with premature death by suffocation. Those present must take first aid measures in these cases.

Treatment & Therapy

Treatment of a tracheoesophageal fistula depends on the primary cause. The symptomatic treatment of the fistula itself corresponds to an invasive operation. In this procedure, the fistula is closed. The connection between the esophagus and trachea is surgically severed and the two systems are made completely separate systems.

In addition to the actual treatment of the fistula, there is a causal therapy that addresses the cause. In the case of esophageal atresia, this causal therapy corresponds to an operation before which the accumulated secretion is drained through a probe. The surgical correction consists of removing the upper part of the esophagus.

The loose parts of the esophagus are connected to each other after removal. If there is too great a distance between the individual parts, an alternative therapy is carried out. This therapy usually corresponds to an extension treatment of the esophagus, which extends over several days or even weeks.

After lengthening treatment, the distance between the two parts is ideally short enough to connect the ends. If the lengthening treatment is unsatisfactory, the surgeon moves part of the stomach or intestines into the chest area to replace the missing piece of esophagus.

The existing connections to the trachea or lungs are severed and sealed tightly. All treatments of the tracheoesophageal fistula can only take place when there is no longer any active pneumonia.

Prevention

The tracheoesophageal fistula can only be prevented to the extent that estrophaguatresia and other primary causes can be prevented.

Aftercare

After the successful treatment of a non-congenital tracheo-esophageal fistula, regular follow-up examinations are necessary because the likelihood of recurrence of a tracheo-esophageal fistula is increased in patients who have had it. For this purpose, regular X-rays and, if necessary, MRI examinations of the esophagus and trachea should be carried out.

In addition, a doctor should be consulted immediately if severe heartburn, reflux (the regurgitation of gastric contents), frequent choking, especially when drinking, or breathing problems occur, as these may be signs of a recurrence of a tracheo-oesophageal fistula. If the fistula developed as a complication of an operation, no further follow-up measures are necessary apart from these controls.

If a tumor was the cause of the fistula development, it is important to also regularly examine the blood for tumor markers in order to detect the recurrence of a tumor at an early stage. If the tracheo-esophageal fistula was congenital, the esophagus and trachea should also be examined regularly during the development of the affected child, since the fistula can rarely form again as the child grows older.

In addition, in the case of a congenital tracheo-oesophageal fistula, any underlying genetic diseases that can lead to malformations (Feingold syndrome, VACTERL association) should be treated for life. Appropriate therapies should be discussed individually with the doctor treating you.

You can do that yourself

A tracheoesophageal fistula must be surgically removed. The patient can support the treatment with some measures and remedies from the household and nature.

First of all, the wound must be carefully cared for and observed after an operation so that complications can be detected at an early stage. If pain, bleeding or other unusual symptoms occur, the doctor must be informed. In addition, if there are signs of a recurrence, you should speak to your doctor. The doctor can suggest suitable preparations or, in severe cases, prescribe prescription ointments.

At the same time, the cause of the formation of the fistula must be determined. If the fistula occurred after an operation, comprehensive tumor prevention is necessary in any case. Especially in the case of malignant esophageal tumors and primary lung tumors, the risk of tumor disease is relatively high.

Finally, rest and protection apply, since the operation and the removal of the fistula place a greater burden on the body. The guideline of the German Society for Pediatric Surgery provides those affected with further tips and information with which the tracheoesophageal fistula can now be treated effectively.

Tracheo-oesophageal Fistula