Letters to the Editor Indian Pediatrics 2005; 42:298 |
Double Fistulae in Esophageal Atresia |
Incidence of double fistula is less than 1 % of all tracheoesophageal fistula(2,3). The existence of upper pouch fistula is underestimated because routine upper pouch contrast studies and preoperative bronchoscopies are not done by most practicing Pediatric surgeons. Some are initially missed and later picked up and thought to be recurrent tracheoesophageal fistulas, Post-mortem diagnosis of missed upper pouch fistula is also reported(2). Workup for missed upper pouch fistulas is recommended in babies who choke during feeds postoperatively and have recurrent pneumonia. They can be differentiated from recurrent tracheoesophageal fistula by bronchoscopy. During surgery a careful mobilization of upper pouch from underlying trachea must be done in every case to rule out an upper pouch fistula(4). Routine preoperative bronchoscopy and upper pouch dye studies will certainly reduce the chances of a missed upper pouch fistula. P.K. Tripathy, |
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