Delayed diagnosis of isolated congenital H-type tracheoesophageal fistula: a case report of surgical repair supported by TachoSil® as an adjunct in chronically inflamed tissues.

Abstract

Background: H-type tracheoesophageal fistulas (TEFs) are rare congenital malformations characterized by an abnormal connection between the trachea and esophagus in the absence of esophageal atresia. These lesions may remain undiagnosed for years due to subtle and non-specific symptoms, often resulting in chronic pulmonary complications. Delayed diagnosis can contribute to the development of long-standing inflammation and fibrosis, which significantly complicates surgical intervention.

Case description: We present the case of a 14-year-old girl with a previously undiagnosed H-type TEF who was treated for recurrent lower respiratory tract infections since early childhood. Her condition acutely worsened with severe respiratory distress requiring hospitalization. Comprehensive imaging, including contrast-enhanced esophagography and chest computed tomography (CT), identified the presence of a congenital H-type TEF with associated chronic peritracheal and paraesophageal inflammatory changes. Surgical repair was performed via a cervical approach. Intraoperatively, significant fibrotic tissue surrounding the fistulous tract posed challenges to dissection and closure. To reinforce the primary suture line and reduce the risk of postoperative complications, a fibrinogen-thrombin-coated hemostatic patch (TachoSil^®) was applied. The patient recovered uneventfully and demonstrated no evidence of recurrence or airway compromise at 12-month follow-up.

Conclusions: This case highlights the importance of heightened clinical suspicion in children with persistent respiratory symptoms. In delayed TEF diagnoses, chronic inflammation should be anticipated. Adjunctive use of hemostatic sealants may enhance surgical safety and improve outcomes in complex cases.