Enhanced estimation strategy for determining the location of tracheoesophageal fistula in a preterm, low-birth-weight infant with congenital esophageal atresia type C and duodenal atresia: a case report

Abstract

Background: In esophageal atresia type C, identifying the tracheoesophageal fistula (TEF) location is crucial for airway management. However, a thin bronchoscope may not always be available.

Case presentation: We report on a low-birth-weight neonate with esophageal atresia type C who required immediate gastrostomy after birth. With no suitable thin bronchoscope available, alternative methods were utilized to estimate the TEF location post-gastrostomy. Submerging the gastrostomy tube tip in water and applying positive pressure ventilation via a tracheal tube allowed for observation of air bubbles emerging from the gastrostomy tube. As the tracheal tube was advanced, the cessation of bubbles indicated that the TEF was sealed by the tracheal tube. The location of the tracheal tube tip, confirmed by chest radiographs, was consistent with the TEF location identified during corrective surgery for TEF.

Conclusions: This innovative technique facilitated successful estimation of the TEF location without bronchoscopy, demonstrating its efficacy in resource-limited settings.

Keywords: Esophageal atresia; Low-birth-weight infant; Preterm; Tracheoesophageal fistula.

Fig. 1

Diagrams illustrating methods for estimating the location of a tracheoesophageal fistula. A This diagram illustrates a scenario in which a tracheoesophageal fistula (TEF) is positioned below the tip of a tracheal tube. In this configuration, air bubbles emerging from a gastrostomy tube indicate the presence of the TEF beneath the tip of the tracheal tube. B This diagram depicts the situation where the tip of the tracheal tube surpasses the location of the TEF. The absence of air bubbles from the gastrostomy tube signals that the tip of the tracheal tube has moved beyond the TEF