Tracheo-oesophageal fistula and the respiratory distress syndrome

Abstract

Four pre-term neonates with tracheo-oesophageal fistula required positive pressure ventilation because of the respiratory distress syndrome. Gastric rupture occurred in two patients, one of whom died. Ineffective ventilation was critically impaired by formation of a gastrostomy in a third patient, who also died. Direct ligation of the fistula in the fourth critically ill patient led to a dramatic improvement in gas exchange. When the resistance of the airways exceeds that of the fistula, gas escapes through the latter into the gastro-intestinal tract. Formation of a gastrostomy lowers intragastric pressure and thus the resistance to gas escape via the fistula; respiratory support is thus rendered ineffective. Effective ventilation is only possible after occlusion of the fistula, which we believe is best achieved by direct ligation.