H-type tracheoesophageal fistula associated with tracheal bronchus: A case report

Introduction: Tracheoesophageal fistula (TEF) is a condition with an abnormal connection between the trachea and the esophagus. Type H, which is a fistula without atresia of the esophagus, accounts for only 4% of all TEF. It manifests as cyanosis, choking during breastfeeding, abdominal distention, and recurrent lung infections. It is frequently overlooked in infancy because the clinical picture is non-specific. A tracheal bronchus, also known as "pig bronchus", is a bronchus that comes off the trachea before the carina, and has a prevalence of 1.5-2% in children. Case presentation: We present a term neonate who developed cyanosis shortly after birth while being breastfed. The patient's clinical status deteriorated and required endotracheal intubation. She subsequently developed severe abdominal distension which was suspicious for a TEF. A contrast esophagogram confirmed the diagnosis. A contrast-enhanced CT (CECT) showed a right tracheal bronchus and also confirmed the TEF. A right thoracotomy was done to ligate the TEF, and the tracheal bronchus was left unrepaired. The patient was discharged after an uneventful recovery. Conclusion: Neonates that exhibit cyanosis and respiratory distress during breastfeeding should be evaluated for a TEF. If found, the treatment is surgical ligation. There is no need to do any surgical treatment of a tracheal bronchus, unless there are clinical complications.