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Tracheoesophageal Fistula

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Tracheoesophageal Fistula

Tracheoesophageal Fistula (TEF) is a rare but serious congenital condition where an abnormal connection (fistula) forms between the trachea (windpipe) and the esophagus (food pipe). This condition affects a newborn’s ability to breathe and feed properly and requires prompt surgical intervention.

Causes

TEF typically develops during early fetal development and is almost always congenital (present at birth). It often occurs alongside esophageal atresia, where the upper and lower segments of the esophagus do not connect properly. The exact cause is unknown, but it may be associated with:

  • Genetic factors

  • Premature birth

  • Other congenital syndromes (like VACTERL association)


Symptoms

Signs of TEF usually appear shortly after birth and may include:

  • Difficulty feeding

  • Coughing or choking while feeding

  • Frothy saliva or drooling

  • Bluish skin color (cyanosis), especially during feeding

  • Abdominal distension due to air entering the stomach


Diagnosis

Diagnosis is typically made soon after birth based on clinical symptoms and confirmed using:

  • Chest X-rays with a feeding tube

  • Contrast studies

  • Bronchoscopy or endoscopy (in complex cases)


Treatment

Surgical correction is the only effective treatment for TEF and is usually performed in the first few days of life. The surgery involves:

  • Closing the abnormal fistula

  • Reconnecting the esophageal segments (if esophageal atresia is present)

  • Postoperative monitoring and nutritional support

In complex cases, multiple surgeries or staged procedures may be required.


Postoperative Care

Post-surgery, infants may need:

  • Temporary tube feeding

  • Antibiotics to prevent infection

  • Breathing support in case of lung involvement

  • Long-term follow-up for swallowing, reflux, or tracheomalacia issues


Prevention

Since TEF is congenital, there is no guaranteed way to prevent it. However:

  • Prenatal care and early screening in high-risk pregnancies can help with early detection

  • Genetic counseling may be advised for families with a history of congenital anomalies

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