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04-21-2008, 11:17 AM
mDiagnosis
1. Symptoms occur late in infancy (usually first month) they include spells associated with cyanosis in association with feeding (more with liquid food).
2. Attacks of pneumonitis, and abdominal distension. The fistula is usually oblique (H shaped fistulas are usually acquired due to malignancy following surgery), and therefore complications are delayed.
3. Barium swallow and bronchoscopy (with the use of methylene blue) help the diagnosis. No surgical exploration is undertaken before definite diagnosis.
mManagement
Most of these fistulae (at least 70%) can be approached through a cervical incision in the right side, where the fistula can be divided. The fistula usually occurs at the level of the second thoracic vertebra.
SOURCE: DR. AYMAN SALEM'S BOOK
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