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Tracheoesophageal Fistula

Tracheoesophageal fistula is a condition where there is a connection between the trachea (windpipe) and the esophagus.


The trachea and the esophagus are in close relationship (esophagus is located behind the trachea). Any disease in the trachea or the esophagus that erodes into the wall of either organ can result in tracheoesophageal fistula.
The most common tracheoesophageal fistula causes include:

  1. Complication of intubation (use of a breathing tube of a respiratory machine). The balloon of the breathing tube can erode from the trachea into the esophagus.
  2. Cancer of the esophagus, eroding into the trachea.
  3. Radiotherapy for treatment of cancer of the neck or chest (radiation-induced tracheoesophageal fistula).


Food and saliva can enter from the esophagus into the trachea, via the fistula, causes coughing following swallowing, and pneumonia. Other tracheoesophageal fistula symptoms can include dysphagia and choking.


Flexible bronchoscopy

This study allows assessing the opening of the fistula inside the trachea.

Upper endoscopy

This study allows assessing the opening of the fistula inside the esophagus.

Computed tomography scan CT scan

CT scan uses X-rays to make detailed pictures of the structures inside the body. The connection between the esophagus and the trachea can be seen as shown below.

Radiation Induced Tracheoesophageal Fistula in a Patient with Esophageal Cancer on CT Scan of the Chest.


Tracheoesophageal fistulas rarely close spontaneously. The treatment depends on the cause and the location of the fistula. The goal of the therapy is to cover the connection between the trachea and the esophagus to prevent aspiration and pneumonia. The main therapies include esophageal stenting, or surgical repair. The surgical repair includes separation of the trachea and the esophagus, repair of the hole in each organ and placement of a muscle between the two organs to prevent future fistula formation.

By Farzaneh Banki, M.D.


1. Reed MF, Mathisen DJ.Tracheoesophageal fistula. Chest Surg Clin N Am. 2003 May;13(2):271-89
2. Sharma P, Kozarek R, and the Practice Parameters Committee of the American College of Gastroenterology. Role of Esophageal Stents in Benign and Malignant Diseases. Am J Gastroenterol 2010; 105:258–273.