[Multiple congenital esophago-tracheal fistulas (excluding atresia of the esophagus). Review of the literature, apropos of a new case].

Congenital tracheoesophageal fistulas (CTOF) without esophageal atresia are uncommon and exceptional when multiple. Authors report a new personal case treated in two times. Others eight cases in literature are studied. Only one pre-operative diagnosis was made. Two old no-operated cases were discovered at autopsy. For five, no clinical modification was noted after the first CTOF surgical care. In them two no-reoperated died and the second fistula was seen after. For the others, the same radiological or endoscopic exams that have not marked the second fistula were positive after surgery. No explanation was done. For a better result, systematic complete investigation of trachea and esophagus are necessary even if first fistula is diagnosed. Luckily per-operative discovery of second fistula (one case) do not allowed initial extensive surgery. To support a second congenital tracheoesophageal fistula after a surgical time, many criterias are necessary: 1. a undoubted fistula recognised during the first intervention; 2. recurrent symptoms after surgery with no free interval; 3. identification by radiology or endoscopy of a new tracheoesophageal shunt in other place that the first; 4. its surgical discovery in no previous dissected area. In all cases where fistulas are described, the aspect is not the same: the upper fistula is a "H" type and the lower is shorter and larger ("X" type). To note a case of three simultaneaous fistulas in the same patient.