Tracheoesophageal fistula is a congenital or acquired pathological condition in which a connection is formed between the lumen of the esophageal tube and the trachea. Such a defect is characterized by a number of specific symptoms and requires mandatory surgical intervention, regardless of the form of the lesion and its severity.
Description of defeat
The channel formed in this condition includes epithelium and granulation tissues. The lesion is diagnosed through radiography, as well as endoscopic examination. ICD tracheoesophageal fistula code - congenital tracheoesophageal fistula without atresia Q39.2.
The disease can be of two forms: congenital and acquired. Congenital tracheoesophageal fistula is detected in 1 out of 3000 children immediately after their birth. Of all the varieties of anomalies, in most cases they are diagnosed with an isolated fistula at the level of the 7th thoracic and first cervical vertebrae. Disease in infants most often resolvesagainst the background of atresia.
Acquired disease is a rather rare occurrence, and in almost all cases it resolves against the background of stenosis of the lumen of the esophagus with additional scarring.
Causes of disease
The congenital form of tracheoesophageal fistula in newborns develops at the stage of separation of the esophageal tube and trachea, which at the first stage are formed from a single germ. The named process begins from 4 to 12 weeks of embryo development in the woman's uterus. Such an anomaly can be suspected during an ultrasound scan - poor visualization of the stomach or underdevelopment of the embryo itself.
The cause of acquired tracheoesophageal fistula is most often the development of oncological formation. The tumor actively develops from the tissues of the esophagus, which leads to a pathological narrowing of its lumen. Risk factors in this case are esophagoscopy with organ damage, bougienage of the esophagus or stenting of the esophageal tube with its subsequent perforation.
Uncommon causes
Esophageal-tracheal fistula can also develop due to a chemical or thermal burn that was received during surgery or damage to the chest and neck. Other less common causes of pathology include:
- damage to the esophageal diverticulum;
- defeated by a bacterial infection;
- lung abscess;
- mediastinitis;
- tuberculosis of the lymph nodes;
- formationbedsores;
- various actively developing inflammation in the body;
- mediastinitis.
Main types of fistulas
Tracheoesophageal fistulas in newborns and older people are divided by doctors into the following types:
- I type - the proximal section of the esophageal tube is connected to the trachea, both ends of the organ are blind at once.
- II type - formation of a fistula between the posterior wall of the trachea and the anterior segment of the esophagus tube.
- III type A - both ends of the organ are blind, a fistula is formed between the lower part of the trachea and the proximal end of the esophagus.
- III type B - a fistula forms between the distal part of the esophagus and the lower part of the trachea, esophageal atresia occurs.
- III type C is the combination of the distal and proximal segment of the esophageal tube with the trachea at different levels with atresia.
Also, experts distinguish between acquired fistulas of a traumatic and tumor nature, formed during a specific or nonspecific inflammatory process.
Possible Complications
When a tracheoesophageal fistula develops, the patient additionally begins a serious purulent-inflammatory process, as a result of which the following diseases develop:
- tracheobronchitis;
- bacterial pneumonia;
- gangrene;
- pleurisy;
- mediastinitis.
When removing the tracheoesophageal fistula, the operation does not exclude the recurrence of the disease. And in this case, the patient will be scheduled for a second surgical intervention. There is a risk of death whenperforming an operation against the background of a complicated condition of the patient due to a severe form of the development of the disease. Also, the patient's refusal to carry out a radical excision of the fistula may result in death. At the same time, in most cases, a purulent complication is actively developing, which is simply incompatible with human life.
Clinical picture
Symptoms of a tracheoesophageal fistula will depend on its location, type and comorbidities. As a rule, in all patients with this condition, a strong attack of coughing begins with the release of small particles of food, there are problems with respiratory activity and other signs of the onset of the spread of inflammation. Tracheoesophageal fistula resolves with the following symptoms:
- paroxysmal cough while eating;
- hoarse voice;
- feeling of suffocation due to lack of oxygen entering the body;
- feeling of a foreign body in the throat.
In the acute form of the disease, the patient additionally develops symptoms of body intoxication with fever, feeling unwell, and complete or partial lack of appetite. Often the anomaly is complicated by aspiration or purulent pneumonia, which adds typical signs of pneumonia to the existing symptomatic manifestations.
The baby begins to have severe choking and coughing fits when feeding, the color of his skin becomes bluish or becomes pale. In addition, the baby has a large amount of excess saliva and problems withswallowing.
Diagnostics
When diagnosing a tracheoesophageal fistula, the doctor prescribes a contrast radiography or esophagography to the patient by inserting a catheter through the patient's oral cavity.
With an external fistula, the patient is offered to drink a contrast agent, and in this case, the diagnosis will be confirmed when a liquid of a different color is released from the fistula or during a coughing fit. If the disorder is highly prevalent, diagnostic measures will also be carried out using a contrast agent, which, at the first sip, will help to identify the disorder.
If the doctor has established all the clinical signs of a fistula, the radiography is replaced by an endoscopic examination with the introduction of a contrast agent. This helps to track the course of the fistula, determine the site of the connection, and, based on the information received, draw up an optimal treatment tactic and an operation plan.
If endoscopy does not give the expected results, then radiography with contrast is performed, which helps to accurately view the defect and even describe the disease in detail. This gives doctors the opportunity to create an effective and comprehensive treatment. Additionally, the patient's biological material is taken for tracheobronchoscopy.
Esophageal fistula is a dangerous condition, which is important to deal with immediately in the first stages of its development.
Providing treatment
The main treatment for tracheoesophageala fistula is considered a surgical procedure. The doctor prescribes medications only for patients with concomitant diseases - such treatment helps to maintain the patient's condition and relieve symptoms.
Before the operation, a specialist can prescribe a set of medications that help reduce the severity of the inflammatory process and get rid of a purulent infection. Such exposure will help to significantly reduce the risk of early postoperative complications.
Surgical intervention will consist in dividing the fistula and excising it. Access will be selected depending on the location of the formation - through the chest, neck or abdomen. After excision of the fistula, damage to the walls of each organ is sutured in turn. The sutures are additionally strengthened by adjacent tissues: omentum, diaphragm, pleura or pericardium.
Other forms of defeat
If, in addition to the fistula, strictures are found in the patient, then the patient is prescribed esophageal plasty using colon tissues. In case of an anomaly with a concomitant hernia of the POD, a Nissen fundoplacion is prescribed.
After surgery, the patient is prescribed medication to quickly recover and prevent the development of an inflammatory or infectious process. In case of a severe purulent complication on the lungs, it will be necessary to excise the segments or completely remove the organ (pulmonectomy).
Recovery afteroperations
After surgery, the patient is fed through a probe, which is most often left for 10 days. On the first day after the operation, feeding is carried out exclusively by intravenous infusion.
Such surgery is usually referred to as a complex surgical procedure, but correct and comprehensive diagnosis, as well as good preparation will help prevent complications after surgery. The prognosis for tracheoesophageal fistula with its timely excision and plastic surgery by doctors is mostly favorable.
After surgery, the patient requires constant monitoring by a doctor, this will help to identify complications in the early stages of their development and also make a comprehensive treatment.
Detailed description of treatment
To get rid of such an anomaly, unfortunately for many, is possible only through surgical intervention. Taking medications and other physiotherapy only for a while helps to alleviate the condition and get rid of complications. During the operation, the fistula is divided and bandaged. In the event that the move is too long, it is pulled over with several ligatures, after which they are crossed with each other. With a wide and short course, a dissection of the esophagus and trachea is performed, as well as stitching the resulting hole. If the operation to excise the fistula is not performed in time, then soon the patient's condition will deteriorate significantly and even death may occur. For a newborn child, surgery is performed inthe first day after birth.
After the operation, the patient is prescribed a course of treatment for pneumonia. A complication after surgery may be a recurrence of the fistula, in which the operation will have to be performed again. It is impossible to refuse it, since such an attitude can provoke the death of the patient.
When combining a tracheoesophageal fistula with esophageal atresia or tracheal stenosis, the doctor conducts separation of the formation with simultaneous circular resection, organ plasty or simultaneous esophageal plasty. If there is a large diastasis between the distal and proximal segments of the esophagus, which does not allow an end-to-end anastomosis, then the upper part of the esophagus is brought to the neck, the fistula is separated and the operation is stopped.
If the tracheoesophageal fistula has arisen due to the collapse of the tumor, then the specialist creates a special artificial entrance to the stomach cavity through the anterior abdominal wall to feed the patient when he cannot take food through his mouth on his own.
Is prevention possible
The problem of prevention of tracheoesophageal fistulas remains relevant for many doctors. Fatal outcomes during surgery for tracheoesophageal fistula account for 10-15 percent of all cases, which in most cases is associated with a severe initial condition of the patient. To avoid dangerous consequences, it is important to carefully consider your state of he alth and, in which case, immediately seek help from a doctor.
