# A Cautionary Tale: Undetected H-type Tracheoesophageal Fistula in an Adolescent Male

## TL;DR

This case report highlights a rare delayed diagnosis of an H-type tracheoesophageal fistula in an adolescent, successfully treated with thoracoscopic surgery.

## Contribution

The novelty lies in the long delay in diagnosis and the successful use of minimally invasive surgery in an adolescent case.

## Key findings

- H-type tracheoesophageal fistula can remain undetected for over a decade.
- Thoracoscopic surgery is an effective treatment option for such fistulas located below the thoracic outlet.

## Abstract

An H-type tracheoesophageal fistula is a rare congenital anomaly consisting of an abnormal passageway between the esophagus and the trachea without the presence of esophageal atresia. This condition is usually detected early in infancy; however, some patients may receive a delayed diagnosis. Symptoms experienced by people affected with an H-type tracheoesophageal fistula vary greatly and may consist of bouts of coughing when swallowing liquids and recurring lower respiratory infections. The most commonly used initial diagnostic tests can produce falsely negative results. The treatment of choice for the majority of H-type tracheoesophageal fistulas is an open surgical procedure; however, the thoracoscopic approach has proven effective in cases where the fistula is located below the thoracic outlet. In this case report, we describe a patient whose diagnosis of H-type tracheoesophageal fistula was delayed by 13 years and who was successfully treated using thoracoscopic surgery.