# Enhanced estimation strategy for determining the location of tracheoesophageal fistula in a preterm, low-birth-weight infant with congenital esophageal atresia type C and duodenal atresia: a case report

## TL;DR

A new method was used to locate a tracheoesophageal fistula in a low-birth-weight infant when a thin bronchoscope was unavailable.

## Contribution

An alternative technique using a gastrostomy tube and tracheal tube was developed for TEF localization in resource-limited settings.

## Key findings

- Air bubbles from the gastrostomy tube indicated the TEF location when sealed by the tracheal tube.
- Chest radiographs confirmed the estimated TEF location matched surgical findings.
- The method proved effective without requiring a thin bronchoscope.

## Abstract

In esophageal atresia type C, identifying the tracheoesophageal fistula (TEF) location is crucial for airway management. However, a thin bronchoscope may not always be available.

We report on a low-birth-weight neonate with esophageal atresia type C who required immediate gastrostomy after birth. With no suitable thin bronchoscope available, alternative methods were utilized to estimate the TEF location post-gastrostomy. Submerging the gastrostomy tube tip in water and applying positive pressure ventilation via a tracheal tube allowed for observation of air bubbles emerging from the gastrostomy tube. As the tracheal tube was advanced, the cessation of bubbles indicated that the TEF was sealed by the tracheal tube. The location of the tracheal tube tip, confirmed by chest radiographs, was consistent with the TEF location identified during corrective surgery for TEF.

This innovative technique facilitated successful estimation of the TEF location without bronchoscopy, demonstrating its efficacy in resource-limited settings.