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Near-missed upper tracheoesophageal fistula in esophageal atresia

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Abstract

Upper pouch tracheoesophageal fistula (TEF) accompanying esophageal atresia (EA) occurs in less than 1% of all EA/TEF variants and could be easily missed after birth. To confront such diagnostic inaccuracy, perioperative tracheobronchoscopy (TBS) and preoperative upper pouch esophagogram (UPEG) have been proposed but are still controversial. We describe the role of UPEG and TBS, used early after birth, in two cases of EA/TEF with upper pouch TE fistulas with unusual high location (one intrathoracic, one subglotic). These upper TE fistulas were almost missed but ultimately detected very early while employing both UPEG and TBS, wherein UPEG was for the diagnosis of TEF and TBS for both intraoperative diagnostic confirmation and aid in TEF identification. We conclude that UPEG and TBS are complementary in detecting near-missed upper TE fistula accompanying EA. Such approach ensures early and accurate diagnosis of EA/TEF variants, thus preventing the complications of a missed congenital upper pouch TE fistula.

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Fig. 1
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Abbreviations

EA:

esophageal atresia

TBS:

tracheobronchoscopy

TEF:

tracheoespophageal fistula

UPEG:

upper pouch esophagogram

References

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Conflicts of interest

There was no funding for this study. There were no financial or any conflict of interest for all authors of this manuscript.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Meyer Children’s Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa, 31096, Israel

    Gideon Shoshany & Arkadi Vatzian

  2. Department of Diagnostic Imaging, Meyer Children’s Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Anat Ilivitzki

  3. Department of Neonatology, Meyer Children’s Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Tatiana Smolkin & Imad R. Makhoul

  4. Department of Pediatric Pulmonology, Meyer Children’s Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Fahed Hakim

Authors
  1. Gideon Shoshany
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  2. Arkadi Vatzian
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  3. Anat Ilivitzki
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  4. Tatiana Smolkin
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  5. Fahed Hakim
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  6. Imad R. Makhoul
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Corresponding author

Correspondence to Gideon Shoshany.

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Shoshany, G., Vatzian, A., Ilivitzki, A. et al. Near-missed upper tracheoesophageal fistula in esophageal atresia. Eur J Pediatr 168, 1281–1284 (2009). https://doi.org/10.1007/s00431-009-0926-z

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  • DOI: https://doi.org/10.1007/s00431-009-0926-z

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