Double H-type tracheoesophageal fistula

Congenital 'isolated' tracheoesophageal fistula (TEF) is a rare variant of esophageal atresia, also termed H-type TEF. Even rarer is a double H-type TEF. Here, we report a two-week-old female, with double H-type TEF - one identified pre-operatively, the other during surgery. Pre-operative laryngotracheobronchoscopy (LTB) with guidewire cannulation is considered key to definitive TEF repair, to aid in both pre- and intra-operative identification of the fistula(e). In our experience, only one H-type TEF was identified at the planned pre-operative LTB, with the second H-type fistula identified at the time of cervical dissection. Both fistulae were repaired during the same operation, via cervical approach. This represents the first reported case of a double H-type TEF, repaired primarily via a single cervical incision.