Intramural tracheoesophageal fistula (TEF) associated with esophageal web.

This is a report of the fourth known case of intramural TEF with diaphragmatic esophageal atresia. These patients present clinically as a typical esophageal atresia with tracheoesophageal fistula, but in effect have the following unusual features: 1) high TEF entering the trachea in the neck; 2) diaphragmatic-type atresia of the esophagus with uninterrupted muscular coat; 3) the location of this diaphragm is at the level of the carina producing in effect a long intramural fistulous tract. It is believed that faulty recannulization of a segment of the esophagus in association with H-type TEF may explain this uncommon anomaly.