How does a patient with a TEF typically present?
In utero, there is often polyhydramnios, as the fetus can-not swallow amniotic fluid secondary to the esophageal atresia. At the time of delivery, an orogastric tube cannot be passed into the stomach. Typically, the orogastric tube will only pass to a distance of approximately 10 cm from the gums. In most cases, the diagnosis is initially suspected at the first feeding, when the neonate presents with coughing, choking and cyanosis (the “three Cs”). Excessive salivation and respiratory distress can also occur.
Confirmation of the diagnosis is made radiographically when a radiopaque orogastric catheter is seen curled in the proximal esophageal pouch. The presence of air in the stomach and intestines on radiography signifies the pres-ence of a fistula between the trachea and distal esophagus.
The “H” type fistula (tracheoesophageal fistula without atresia) usually presents later in life, most commonly with choking during feedings and recurrent pneumonitis.