H-type tracheoesophageal fistula associated with tracheal bronchus: A case report

Tracheoesophageal fistula (TEF) is a condition with an abnormal connection between the trachea and the esophagus. Type H, which is a fistula without atresia of the esophagus, accounts for only 4% of all TEF. It manifests as cyanosis, choking during breastfeeding, abdominal distention, and recurrent lung infections. It is frequently overlooked in infancy because the clinical picture is non-specific. A tracheal bronchus, also known as “pig bronchus”, is a bronchus that comes off the trachea before the carina, and has a prevalence of 1.5–2% in children. We present a term neonate who developed cyanosis shortly after birth while being breastfed. The patient's clinical status deteriorated and required endotracheal intubation. She subsequently developed severe abdominal distension which was suspicious for a TEF. A contrast esophagogram confirmed the diagnosis. A contrast-enhanced CT (CECT) showed a right tracheal bronchus and also confirmed the TEF. A right thoracotomy was done to ligate the TEF, and the tracheal bronchus was left unrepaired. The patient was discharged after an uneventful recovery. Neonates that exhibit cyanosis and respiratory distress during breastfeeding should be evaluated for a TEF. If found, the treatment is surgical ligation. There is no need to do any surgical treatment of a tracheal bronchus, unless there are clinical complications.