Recurrent Tracheoesophageal Fistula and Respiratory Failure: The Role of Early Airway Endoscopic Approach.

Tracheoesophageal fistulas (TEFs) represent uncommon congenital communications between esophagus and trachea and despite precocious surgical repair their recurrence still represents an important challenge for pediatric surgeons. Recurrence of the TEF occurs in ~9% of cases, most often 2 to 18 months after initial repair.[1] While respiratory symptoms have been reported frequently (22/26 cases of recurrent TEF by Bruch et al[2]), the occurrence of severe respiratory failure in association to TEF is quite uncommon. In fact, symptoms are often difficult to differentiate from tracheomalacia or gastroesophageal reflux, commonly found in infants with repaired esophageal atresia (EA)/TEF. Bronchoscopy may be used in intensive care setting both to confirm diagnosis and to treat lesions. Fistula treatment may be definitive or even transient, permitting pulmonary condition improvement and delay in surgical repair.