Congenital broncho-esophageal fistula; presenting as recurrent pneumonia in a 10-years-old child: A case report.

BACKGROUND AND IMPORTANCE: Congenital broncho-esophageal fistula (BEF) is a rare developmental anomaly where there is an abnormal communication between the esophagus and the bronchial tree. Unlike tracheoesophageal fistulas (TEF) which is often diagnosed in neonates, isolated BEF may go undiagnosed until later age and present as recurrent respiratory infections or chronic cough triggered by feeding. The problem may go undiagnosed as it is often mistaken for other common causes of cough in children like pneumonia and bronchial asthma or other hyperactive airway diseases.

CASE PRESENTATION: This is a case of a 10 years old female who presented with recurrent pneumonia and chronic cough exacerbated by feeding and episodes of choking. She had multiple admissions since early ages and was treated with antibiotics. No remarkable physical finding on the systemic examination except for crepitations on the right lower lung fields. Routine laboratory tests were performed and diagnosis confirmed by imaging which showed a broncho-esophageal fistula connecting the esophagus to the right main bronchus. After a course of parenteral antibiotics, a right postero-lateral thoracotomy with surgical division and closure of the fistula was performed, and finally she he was discharged in good condition on the 8th postoperative day.

CLINICAL DISCUSSION: Congenital BEF is a rare anomaly caused by incomplete separation of the foregut during embryogenesis resulting in a communication between the esophagus and the bronchial tree, and it is estimated to be less than 0.1 % of all congenital anomalies. This communication allows ingested material such as food, saliva and gastric contents to enter the airway and patients are prone to chronic pulmonary inflammation, recurrent respiratory infections and eventually bronchiectasis. Patients with BEF often present with recurrent pneumonia to the same pulmonary segment, chronic cough worsened by swallowing, choking episodes and occasionally hemoptysis. In this case the patient's recurrent pneumonia, chronic cough on feeding and choking on liquids were the hallmarks of esophago-respiratory communication.

CONCLUSION: This case highlights the importance of considering congenital broncho-esophageal fistula in children with recurrent respiratory infections and feeding related cough. The key to a prompt diagnosis and timely treatment remains high index of suspicion and considering a diagnostic imaging (barium esophagogram) in such patients.