Life-threatening Choking Caused by Unrecognized H-type tracheo-esophageal Fistula

導致嚴重窒息的被忽略的H型氣管食道廔管

林永祥(Yung-Hsiang Lin) ； 顧明修(Min-Sho Ku) ； 孫海倫(Hai-Lun Sun) ； 巫堂鎥(Trang-Tiau Wu) ； 呂克桓(Ko-Huang Lue)

《中華民國兒童胸腔醫學會雜誌》 6卷1期 (2009/10) Pp. 47-51

https://doi.org/10.6322/JPRD.200910_6(1).0007

摘要

H型氣管食道廔管為一種相當少見的先天性異常，雖然自出生以後會有反覆性咳嗽，窒息等典型症狀，但經常被忽略了。我們報導一位具有H型氣管食道廔管的2個月大女嬰，她在出生之後就有典型的症狀與徵候，包括曾經兩次導致嚴重窒息，需要急救和插管治療，但卻沒有被兩所醫學中心和三所地區醫院診斷出來，最後再本院經由食道攝影證實，並經外科手術矯正之後，病人症狀完全根除。

關鍵字

H型氣管食道廔管 ； 嚴重窒息

並列摘要

H-type tracheo-esophageal fistula (TEF) is a rare congenital anomaly. Although typical symptoms, such as easy choking and frequent cough, are often noted since birth, the disease is frequently not recognized. We report a 2-month-old infant with H-type tracheo-esophageal fistula. She had symptom/signs of TEF at birth, but the disease was not considered by pediatric facilities at two centers and three local medical departments. Two episodes of life threatening choking were noted at 2 m/o. The choking was so severe that cardiopulmonary resuscitation and ventilator use was necessary. The disease being suspected and then confirmed by esophagography, surgical treatment was arranged. Since surgical treatment, the patient has well with no further episodes of choking.
H-type tracheo-esophageal fistula (TEF) is one subtype of congenital esophageal anomaly. Patients with H-type fistula often suffer from choking, and its complications, such as aspiration pneumonia and asphyxiation were the major cause of mortality and morbidity before the 1940s. Surgical repair has become the standard treatment since the 1940s; its complications were rare and survival rates were high. Early diagnosis and treatment are the major factors for better outcome in recent years. Unfortunately, early diagnosis is still a challenge today. Clinicians' failure to recognize the disease is the major cause. Technical examination that cannot totally diagnose the disease is another reason. Here we report one case with frequent choking since birth, but it was not timely diagnosed. Due to a lack of awareness by physicians, two episodes of severe choking almost deprived her of life. We will discuss why H-type fistula is often not diagnosed early by clinical evaluation, and the difficulties of technical examination.

並列關鍵字

H-type tracheo-esophageal fistula ； severe choking