Tracheoesophageal Fistula

I'm caring for an interesting patient who has what's known as a tracheoesophageal fistula. This is basically a situation in which the trachea (otherwise known as the windpipe) and the esophagus (the food chute) are connected by a small passageway. It occurs in about 1 in every 4500 live born babies. My patient who is only mildly premature, started having some unexplained respiratory distress especially with feedings. It was also noted that there was difficulty passing an orogastric tube. On xray, the tube was noted to be coiled in the upper esophagus (a situation which is diagnostic of TE fistula).
Most patients with TE fistula have a short upper esophagus which ends in a blind pouch (a problem called esophageal atresia). They also have a lower segment of esophagus which connects with the trachea and the stomach. Occasionally, there will be a continuous esophagus and trachea which are connected somewhere in the middle (this is known as an "H-type" fistula).
To correct this, a surgeon enters the chest cavity and closes the connection between the trachea and the esophagus. He then attempts to connect the two ends of the esophagus. Sometimes, the two segments of esophagus are too far apart and some growth is required before esophageal connection can be done. If this is the case, then a tube is surgically inserted through the skin into the stomach (called a gastrostomy tube) as a method of feeding until the child is big enough to connect the two ends of the esophagus.
My patient had his trachea and esophagus separated surgically and was able to have his esophagus repaired during the same operation.