A tracheoesophageal fistula (TEF, or TOF; see spelling differences) is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy. Presentation
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. Esophageal atresia and the subsequent inability to swallow typically cause polyhydramnios in utero. Rarely it may present in an adult. Complications
Surgical repair can sometimes result in complications, including:
Stricture, due to gastric acid erosion of the shortened esophagus
Leak of contents at the point of anastomosis
Recurrence of fistula
Gastro-esophageal reflux disease
Dysphagia
Asthma-like symptoms, such as persistent coughing/wheezing
Recurrent chest infections
Tracheomalacia

Associations
Neonates with TEF or esophageal atresia are unable to feed properly. Once diagnosed, prompt surgery is required to allow the food intake. Some children experience problems following TEF surgery; they can develop dysphagia and thoracic problems. Children with TEF can also be born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities. 6% of babies with TEF also have a laryngeal cleft. Cause
Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges after the fourth week of embryological development.A fistula, from the Latin meaning a pipe, is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-esophageal fistula it runs between the trachea and the esophagus.
(For the purposes of this discussion, proximal esophagus indicates normal esophageal tissue arising normally from the pharynx, and distal esophagus indicates normal esophageal tissue emptying into the proximal stomach.) Treatment
It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Babies often need to spend time in a neonatal intensive care unit for feeding with a stomach feeding tube. Antibiotics, pain relief, a chest drain, oxygen, and ventilation may all be needed. References


== External links ==