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Recurrent fistula​

After repair of OA/TOF, the oesophageal anastomosis sits right next to the suture line on the trachea where the TOF was divided.

Sometimes during the healing process the fistula can reform, often in association with an anastomotic leak. This is called a recurrent TOF.

A recurrent TOF is uncommon, but serious. Recurrent fistulas occur early on, but sometimes the diagnosis is not obvious until later in childhood, sometimes not for several years.

A recurrent TOF typically results in recurrent chest infections because milk or other fluids trickle through the fistula into the airway.

Sometimes this is accompanied by coughing or choking with feeds, although this symptom is also seen in babies with an anastomotic stricture.

If recurrent TOF is suspected, a contrast swallow x-ray and a bronchoscopy are necessary to confirm the diagnosis.

A contrast swallow x-ray involves taking a series of x-rays as the baby swallows a special dye (contrast medium or barium). The radiologist looks for contrast in the trachea.

Bronchoscopy requires a general anaesthetic but is a more definitive test.

Some surgeons try using ‘superglue’ to close a recurrent TOF, but this usually fails and further surgery through the chest is needed to close it.

Contrast swallow showing a recurrent TOF
Contrast swallow showing a recurrent TOF

Would you like more information?

Published by TOFS, The TOF Book is the must have guide for anyone affected by, or caring for someone with OA/TOF.

With contributions from medical experts, the TOF Book contains chapters on every aspect of OA/TOF and VACTERL condition, from infancy to adulthood all presented in an easy-to-understand format.