1. „H‟type
Tracheo-esophageal Fistula
SPEAKER- DR. VIJAYLAXMI SHRIVASTAVA
DR. ASHWIN.A.JAISWAL
MODERATOR- DR.M.K.MOHANTY
DEPARTMENT OF PAEDIATRIC SURGERY
J.L.N.H & R.C, BHILAI
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2. SIMMY
3 MONTHS/FEMALE
NONCONSANGUINOUS
MARRIAGE
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3. NASAL REGURGITATION OF
FEEDS SINCE DAY 15 OF LIFE
RECURRENT PNEUMONIA
SINCE BIRTH
CHOKING ON FEEDING
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4. HOSPITAL DELIVERY
LSCS-MSAF
VIGOROUS AT BIRTH
BREAST FEEDING
PHYSIOLOGICAL JAUNDICE
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5. NASAL & ORAL
REGURGITATION OF FEEDS
ON LYING SUPINE EVEN
AFTER BURPING
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6. RECURRENT PNEUMONIA
TREATED ON OPD BASIS FOR
10 DAYS
ADMITTED FOR PNEUMONIA
FOR 15 DAYS THRICE IN 3
DIFFERENT HOSPITALS
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7. REFERRED TO OUR HOSPITAL FOR
NONRESOLUTION OF SYMPTOMS
PEDIATRICIANS TREATED
PNEUMONIA WITH ANTIBIOTICS
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12. PREOPERATIVE MANAGEMENT
PROPPED UP POSITION
MINIMAL HANDLING
PROKINETIC AGENTS
THICK SMALL FEEDS
PNEUMONIA WAS TREATED
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13. PLANNED FOR SURGERY
PRIOR TO SURGERY PATIENT
HAD PNEUMONIA TWICE
EFFICIENTLY TREATED
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14. ESOPHAGEAL ATRESIA &
TRACHEOESOPHAGEAL FISTULA
COMMON LIFE-THREATENING MALFORMATIONS
INCIDENCE OF 1 IN 3500 TO 1 IN 4500 BIRTH
EQUAL SEX DISTRIBUTION / SLIGHT MALE PREPONDERANCE
ASSOCIATED WITH CONGENITAL ANOMALIES
(40-55%)
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21. Type D -EA with proximal & distal TEF‟s(<1%)
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22. Type E - TEF without EA/ H-type fistula (4%)
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23. „H‟ TYPE TEF
lamb ( 1873)
Rare, isolated type of tef,4-5%
m>f
Level of fistula-2nd thoracic vertebra
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24. „H‟ TYPE TEF
70% occurs at /above the level of 2nd thoracic
vertebra ( high as C7 and as low as T4)
Types – „N‟ type & „H‟ type
Oblique course –tracheal end cranially while
esophagus caudally
„N‟ type > „H‟ type
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25. „H‟ TYPE TEF
Classical triad of symptoms
Coughing & choking precipitated
by feeds with or without
cyanosis
Recurrent lower respiratory
tract infections
Gaseous abdominal distension
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26. „H‟ TYPE TEF
Excessive tracheal secretions with bubbly
respirations
Improvement of symptoms with gastric tube
feedings
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27. „H‟ TYPE TEF
Delayed diagnosis
Least associated with congenital anomalies (25-
30%)
Incidence of polyhydramnios is rare & lbw is less
common
Better prognosis
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28. DIAGNOSIS
High clinical suspicion
Cine esophagogram
Rigid / Flexible Bronchoscopy
CTscan /MRI / Radionuclide esophagogram
Thoracoscopy
Measurement of respiratory flow in esophageal
lumen & o2 conc. in stomach
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