Esophageal and tracheal fistulae: What you need to know

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Danang International General Hospital
Esophageal and tracheal fistulas can cause serious complications, even death, if not detected and treated early. This condition can be caused by many reasons, sometimes it is difficult to detect the disease because the symptoms are not clear.

1. What is esophageal and tracheal fistula?

Fistulas of the esophagus (the tube connecting the throat to the stomach) and the trachea (the tube leading from the throat to the stomach) are conditions that can have many causes.
Esophageal and tracheal fistula is a condition in which there is an abnormal opening between the esophagus and the trachea, leading to food when eaten by the child from the esophagus through the fistula into the lungs, causing pneumonia.
Complications of esophageal and tracheal fistulas:
Choking food into the respiratory tract, causing a lot of coughing in mild, severe cases can be fatal. Long-lasting and often recurrent lower respiratory tract inflammation: food or digestive juices can pass through the fistula into the respiratory tract causing an inflammatory reaction, which recurs many times if the fistula is not treated.

2. Causes of esophageal and tracheal fistula

Common causes of esophageal and tracheoesophageal fistula include:
Congenital abnormalities: Babies can have congenital malformations of esophageal and tracheal fistulas during their formation in the womb. However, this birth defect is very rare with an incidence of about 1 in 3000 births, which can be accompanied by other birth defects. Due to complications when performing medical techniques such as: Intubation, tracheostomy. Trauma: Puncture wounds, puncture wounds, or firearm wounds that can sometimes be overlooked initially.

3. Symptoms of esophageal and tracheal fistula

Choking into the airways: Appears signs of choking after eating or drinking water, the patient coughs violently, cough lasts, more severe may appear cyanosis, difficulty breathing. There is foam, white bubbles in the patient's mouth. Sometimes due to an amount of air from the trachea into the esophagus, the patient has abdominal distension, discomfort or vomiting. With children, they may find it difficult to breathe when they breastfeed. If the patient shows signs of coughing or choking after an accident or medical procedure after eating, it may suggest a leak in the esophagus and trachea. Frequent bronchitis, recurrent pneumonia, even the most severe in young children.

4. Method of diagnosing esophageal fistula

To diagnose the disease, it is necessary to rely on suggestive clinical signs and on the basis of subclinical signs such as:
X-ray: This is a method of using contrast material, then using X-rays to have The fistula can be determined, its location and size, combined with X-ray examination when the patient swallows, can determine the esophageal and tracheal fistula. However, the use of contrast material when examining to identify esophageal and tracheal fistulas needs attention, because the contrast medium can pass through the fistula into the respiratory tract. Endoscopy: In suspected cases, give the patient a small amount of methylene blue to drink slowly and watch for blue into the trachea. In cases of small fistulas, when air is inflated through the endotracheal tube, the sound of air and water can be heard in the epigastrium with the rhythm of the pump. Using endoscopy it is sometimes difficult to detect small fistulas.

5. Treatment Methods

When determining a medical condition that requires monitoring and treatment to avoid dangerous complications, treatment includes medical and surgical methods
Medical treatment:
Elevating the head to avoid reflux and aspiration stomach into the respiratory tract. Use a cannula to continuously suck mucus and saliva from the mouth, preventing the patient from swallowing mucus that flows into the respiratory tract. Insert a nasogastric tube to let the patient eat and drink through the tube, preventing aspiration into the respiratory tract when the patient eats. The patient should not eat or drink to avoid choking on the airways. Treat respiratory complications if any. Surgical treatment:
Need medical care to stabilize the patient's condition, especially pay attention to the health status of children with congenital malformations of the esophagus and trachea because they may be accompanied by other malformations Not healthy enough for surgery. When the patient's health is stable, surgery should be performed. Depending on the cause of the esophageal and tracheal fistula, the location and size of the fistula, appropriate surgical measures are proposed.
Surgery aimed at separating the trachea and esophagus, occluding the esophageal and tracheal fistula.
Esophageal and tracheal fistula is a dangerous condition, which can cause sudden death due to an amount of food or water entering the airways through the fistula, causing acute respiratory failure or complications of respiratory infection. prolonged, frequent recurrence. Especially with young children, sometimes the children's signs are not clear, causing parents not to get out early, leading to many complications. So, if you see that your child has abnormal symptoms when feeding, you need to go to a medical facility for examination to avoid causing dangerous complications for a long time.
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