A tracheoesophageal fistula (TO fistula) is an opening between the oesophagus and the trachea that usually is not part of a person’s anatomy. The oesophagus and the trachea are two tubes that run next to each other down the throat. The oesophagus allows for food to move from the mouth into the stomach. The trachea, also known as the windpipe, moves air from the nose and mouth to the lungs.
A TO fistula can occur in more than one place between the oesophagus and the trachea. Children with a TO fistula run the risk of passing fluids into their trachea and down to the lungs when they swallow, potentially causing breathing complications.
Oesophageal atresia is a condition that causes a TO fistula automatically. In a baby with oesophageal atresia, the oesophagus forms in two separate parts. One part is attached to the wall of the throat and the other to the stomach, but the two are not attached to one another. This leaves an opening, or a fistula, between the trachea and the oesophagus for fluid to pass through, potentially causing breathing complications.
Common symptoms of TO fistula or oesophageal atresia include:
Since TO fistula and oesophageal atresia are birth defects, the symptoms commonly associated with the disorders are usually spotted right after birth.
TO fistula and oesophageal atresia are birth defects caused by improper foetal development. The trachea and oesophagus are one tube very early in pregnancy. Between 4-8 weeks, they are split. TO fistula or oesophageal atresia occurs if this split fails or does not occur properly.
Risk factors for TO fistula and oesophageal atresia include the presence of Trisomy 13 (Patau syndrome), Trisomy 18 (Edward’s Syndrome) or Trisomy 21 (Down Syndrome) in the developing foetus, digestive tract issues, heart malformations, kidney and urinary tract issues, muscular or skeletal issues, and VACTERL syndrome.
If your doctor suspects your child may have TO fistula or oesophageal atresia, they will take a thorough medical history and physical examination. A chest and stomach X-ray will confirm the diagnosis so your doctor can better visualise your child’s anatomy.
When diagnosing TO fistula or oesophageal atresia with an X-ray, your provider will likely suggest putting your child under a short-term sedative so that they can guide a tube down your child’s oesophagus. This tube will be visible on the x-ray and help the doctor see where, if anywhere, there is space between the oesophagus and the trachea.
TO fistula can lead to pneumonia, and oesophageal atresia can lead to malnutrition. A child with TO fistula without oesophageal atresia may take fluid into their lungs. If the fluid is not removed, they may develop an infection. With oesophageal atresia, there is no way for liquid or any nutrient to reach the child’s stomach since the oesophagus is in two parts. The child may need to receive supportive nutrition.
Treatment for TO fistula and oesophageal atresia is surgery. Since both conditions are typically diagnosed right after birth, when surgery takes place will depend on how healthy the child is and their current symptoms. Surgery closes any holes between the trachea and oesophagus and pieces the oesophagus back together.
Children born with TO fistula or oesophageal atresia may have trouble swallowing, even after successful surgeries. This can be due to the buildup of scar tissue or the development of chronic reflux disease. Working with your child’s care team after surgery is vital to ensure successful recovery and healthy growth and development.