What is a Tracheoesophageal Fistula?

A tracheoesophageal fistula is a connection between the esophagus and the trachea. These two structures are normally not connected, and the connection represents a very serious medical problem. These fistulas are usually congenital, occurring because of an error which happened during fetal development, but sometimes they can emerge later in life, as for example in the form of a complication of surgery performed in these region. The fistula is repaired in a surgery in which the connection is broken off and the esophagus and trachea are repaired.

Often, tracheoesophageal fistula appears with a condition called atresia. In atresia, the upper part of the esophagus ends in a pouch, instead of connecting with the lower part and the stomach. People with atresia, in other words, can eat, but the food does not enter their stomachs. When the pouch fills up, the food may spill over into the trachea through the fistula. When it enters the trachea, it can bubble back up into the mouth, or flow into the lungs, which can generate complications for the patient.

Babies with atresia and/or tracheoesophageal fistula have some classic symptoms. They have difficulty feeding, often drool, and may cough, choke, or even turn blue while attempting to feed or after eating. A pediatrician can diagnose a tracheoesophageal fistula and recommend surgery to correct the issue. Depending on the precise nature of the defect, a surgeon may perform two different surgeries to address the atresia and the fistula. The surgeon can use imaging studies to learn more about the situation and provide parents with information about what to expect.

Having a tracheoesophageal fistula can be very dangerous. If people aspirate food through the fistula, they can develop pneumonia. Aspiration of food can also cause choking and coughing, and may interfere with the airway, potentially putting someone at risk. Tracheoesophageal fistulas are very repairable with surgery and it is important to receive treatment for comfort and quality of life, and to prevent complications such as malnutrition and pneumonia.

Parents who cannot afford surgery to treat a tracheoesophageal fistula may be able to access assistance through programs which pay for surgeries to address birth defects. These programs may be run by private groups or government agencies, and are designed to help parents care for children with such conditions by providing them with financial assistance which can help pay for surgery, consultations with doctors, housing during treatment, and other needs. A pediatrician can provide parents with information about programs which may be useful.