Recurrent tracheo-esophageal fistula: a protocol for investigation.

Following repair of esophageal atresia and tracheo-esophageal (TE) fistula, the fistula may recur in approximately 10% of patients and is often difficult to diagnose. The authors review the clinical and radiographic findings in 16 cases. Clinical findings are nonspecific; however, recurrent TE fistula may be suspected when the plain radiograph reveals an air esophagram (44% of cases), gas in the abdominal portion of the bowel (50% of those who had abdominal radiographs), or a "beaked" appearance of the anterior wall of the esophagus (50% of negative barium examinations). Oral barium studies resulted in 17 false negatives and 4 true positives, while a right lateral decubitus esophagram with a vertical beam gave 2 false negatives and 2 true positives, and a prone esophagram with a horizontal beam gave 2 true positives and no false negatives. Despite the small number of cases, the authors suggest that a prone view with a horizontal beam, rather than a decubitus examination, is the procedure of choice for recurrent TE fistulas.