Congenital tracheal problems are all rooted in the same area. It’s a problem with the way it was formed. Essentially what happened is when that your trachea and esophagus form from the same tube in your foregut. They are eventually separated by the tracheoesophageal septum. When things go wrong, you have a tracheoesophageal fistula.

Tracheoesophageal fistulas are sort of like an unwanted path between the trachea and esophagus. What is the problem with this? Think about what they do and where they lead to. The trachea is meant for breathing and transferring air to your lungs. The esophagus is for food and drink and bring things to your stomach. What happens when those cross over? Yeah, you could get some air in your stomach but the big issue is the transference of food and drink to your lungs.

Usually when this happens, the infant will also have esophageal atresia (like it is cut off or didn’t fully form) and polyhydramnios (too much fluid in the amniotic sac). You’ll also see evidence of it that will just make sense. After they eat, they’ll be gagging and cyanotic, pneumonitis will occur, you won’t be able to pass a catheter into the stomach, and you’ll see air in the stomach, too. That all makes a ton of sense, right?

The most common tracheoesophageal fistula (something like 80%) occurs when the fistula happens in the last third of the trachea and the esophagus has atresia up to that point. So there is no open path from the esophagus all the way down, just from the trachea. Look for a lot of air in the bowels from this one. Right?

10% will have only the esophageal atresia and no actual fistula. So, there will be no risk of milk being passed into the airway, but they also won’t have anywhere else to put it.

The third kind, which is only 6% of cases is the H type. Everything forms as needed, no atresia, except for the addition of the fistula. So the esophagus is normal, the trachea is normal but you have that pathway in between the two.

Fourth most common (2%, so not really common) is the like a double fistula. The esophagus comes down, has an abnormal connection to the trachea and there is the break in the formation of the esophagus. A little further down the trachea is another abnormal pathway that hooks it back up with the rest of the esophagus.

Last, and least popular (less than 1%) is the esophagus that has a pathway in the first part, and just straight up quits. That’s not entirely right, there is a distal part coming up off the stomach, but unlike the earlier example there is not another fistula reconnecting the distal esophagus with the trachea.