Tracheoesophageal Fistula

What is a tracheoesophageal fistula?

A tracheoesophageal fistula (TEF) is an abnormal connection between your trachea and esophagus. Your trachea brings air into your lungs. Your esophagus carries food from your mouth to your stomach. A TEF can cause food to pass from your esophagus into your trachea and lungs. This can cause breathing problems or infections, such as pneumonia.

What causes a TEF?

TEF may be caused by an injury to the neck or chest. A mechanical ventilation or a tracheostomy tube placement can cause TEF. Tumors, infections, or nasogastric tube placement may also cause TEF. Sometimes a child is born with TEF.

What are the signs and symptoms of a TEF?

The signs and symptoms of TEF depend on the size of the fistula. Your signs may be different if you are on a ventilator. You may have one or more of the following:

  • Chest pain, shortness of breath, or labored breathing

  • Coughing or choking when eating or drinking in those who are not on a ventilator

  • Drooling or excess mucus in the mouth.

  • Enlarged abdomen

  • Swallowed food or liquids are coughed out or suctioned from the airways

  • Wheezing or bubbly sounds following each breath

How is a TEF diagnosed?

  • An barium x-ray of your throat and esophagus may show the fistula. You will drink a thick, milky liquid called barium. Barium helps your fistula show up clearly on the x-ray.

  • A bronchoscopy is a procedure to look for a fistula inside your airway. A thin tube with a light and camera is inserted into your mouth and moved down your throat to your airway. You will be given medicine to numb your throat and help you relax during the procedure.

  • A CT scan may show the fistula. You may be given a dye before the scan. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.

  • An endoscopy is a procedure to look for a fistula inside your esophagus. A thin tube with a light and camera is inserted into your mouth and moved down your esophagus. You will be given medicine to numb your throat and help you relax during the procedure.

How is a TEF treated?

  • Medicines help relieve your symptoms or treat or prevent a bacterial infection.

  • Extra oxygen may be needed if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.

  • A stent (tube) may be placed in your esophagus or trachea to keep it open.

  • Surgery may be needed to close or fix the fistula. The esophagus may be reconnected to make it a continuous tube that is separate from the trachea. In some cases, a piece of tissue from the large bowel is used to join the parts. Ask your healthcare provider for more information about surgery.

When should I contact my healthcare provider?

  • You have a fever, chills, or a cough.

  • Your voice has changed or become hoarse.

  • Your skin, lips, or fingernails are pale or bluish in color.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You are choking and cannot breathe.

  • You are coughing or vomiting blood.

  • You have trouble swallowing or drinking.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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