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Acquired tracheoesophageal fistula in infancy and childhood
1Department of Pediatric Surgery, Hadassah University Hospital Mount Scopus, Jerusalem, Israel.
Insights
Pediatric acquired tracheoesophageal fistula (TEF) is rare. This report details two cases caused by pistachio nut shells, requiring repeat surgery and specialized flap repair for successful treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pulmonology
Background:
- Acquired tracheoesophageal fistula (TEF) is an uncommon condition in children.
- Foreign body ingestion can lead to serious complications, including TEF.
Observation:
- Two pediatric patients presented with acquired TEF attributed to pistachio nut shell ingestion.
- Initial surgical repair was insufficient in both cases, necessitating a second intervention for recurrent fistula.
Findings:
- The acquired TEF in these cases presented unique challenges requiring delayed surgical intervention.
- Successful management involved meticulous separation of the respiratory and alimentary tracts using an intercostal muscle flap.
Implications:
- This case series highlights the importance of considering unusual foreign bodies in pediatric TEF etiology.
- Delayed surgical intervention and the use of muscle flaps are crucial for managing complex or recurrent pediatric TEF.
- Improved diagnostic and treatment strategies are needed for rare pediatric acquired TEF cases.
Abstract:
Acquired tracheoesophageal fistula (TEF) is a rare entity in the pediatric age group. We report two pediatric patients with acquired TEF caused by shells of pistachio nuts. In both patients the primary operation did not resolve the problem and a second intervention for recurrent fistula was needed. The special nature of acquired TEF, particularly the one described herein, requires delayed surgical intervention and meticulous separation of the respiratory and alimentary tracts by an intercostal muscle flap.