Definition

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

Causes

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 causes of tracheoesophageal fistula 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).

Symptoms

Food and saliva can enter from the esophagus into the trachea, via the fistula, causing cough following swallowing, and pneumonia. 

Diagnosis

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.

Treatment

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.