In one hospital, the diagnosis of excessive tight Nissen’s fundoplication was made and he underwent laparoscopy, takedown of Nissen’s fundoplication, and had a partial wrap performed. He even had a stress test and a cardiac catheterization performed for the symptom of chest discomfort. In all of the above tests, the TEF was there but was missed by the examining physicians. The esophagus was grossly dilated, and air filled. CT scan demonstrated severe cystic bronchiectasis especially of the right upper lobe. Multiple CT chest, barium swallow ( Figure 1), and EGD were performed but the diagnosis was missed. He was seen by multiple pulmonary, gastrointestinal, and cardiac specialists. In the 2 years prior to presentation, he was admitted to three other area hospitals repeatedly. As a result, he also developed severe depression. He suffered from recurrent pulmonary infection and was repeatedly hospitalized. The gastrostomy tube was removed when he was 4 years old but his coughing and regurgitation during meals persisted. He was diagnosed to have “severe reflux” when he was a baby and Nissen’s fundoplication together with gastrostomy tube was performed. A good history and meticulous examination of the radiological examinations will help make the diagnosis.Ī 32-year-old man gave history that he had been throwing up when he tried to eat since he was a baby. This report is adding three patients to the limited world experience. Only about 20 adult congenital H-type TEFs have been reported in the English literature ( 4- 12). Heightened alert regarding this condition is needed to allow early diagnosis and treatment. The oldest patient reported was 79 years old ( 4).īecause of constant aspiration, these patients suffer from recurrent pulmonary infection which can be fatal. The first successful transcervical repair was performed in 1939 by Imperatori ( 3). The first report of a congenital tracheoesophageal fistula in an adult was in 1929 ( 2). It was first described by Lamb in 1873 ( 1). This is the rarest type of congenital TEF, constituting only 4% of all congenital TEFs or about 1 in 100,000 live births. However, the H-type, which is not associated with esophageal atresia, may escape diagnosis in childhood and presents in the adult. They are usually associated with esophageal atresia and therefore discovered and treated during the neonatal period. Congenital tracheoesophageal fistulas (TEFs) are rare.
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