Fistulas at neonatal and infantile period are frequently encountered at this age group. Our study included 34 cases of neonatal and infantile fistula. To our knowledge, no previous literature reported a diverse collection of neonatal and infantile fistula. Most of the reported literatures concentrated upon a single type of them [13,14,15]. GIT and urinary fistulas are the most common fistulas enrolled in this series.
Tracheo-esophageal fistulas (distal, proximal, or H shape) were found in our study in 8 cases. These results were seen in another report [16]. Esophageal atresia with distal tracheo-esophageal fistula was the most common type. Iatrogenic esophago-cutaneous fistula or esophago-pleural fistula was encountered in 2 cases in our study. Esophago-cutaneous fistula may occur after the repair of esophageal atresia as a leakage at the site of incision. This complication was reported in another German report covering a big population [17]. Esophago-pleural fistula is reported in 2 cases in pediatric age group [18].
Branchial fistula was seen in one case in our work. On fistulogram, the tract ended in a cavity. Two cases of infantile thyroglossal fistula were found in our study. These fistulas were observed in other studies [19, 20].
Vitello-intestinal fistula is a non-atretic congenital duct between the umbilicus and the small intestine. It was found in 3 cases in this work. It was reported in many literatures [21]. Urachal fistula is a patent urachus with dripping of urine from the umbilicus. It was found in one case in our series. It was reported in other literatures [22, 23].
Ano-rectal malformations are frequently associated with neonatal fistula especially with imperforate anus. Congenital neonatal recto-urinary fistulas were found in 9 cases in our study. It may be recto-vesical (one case), recto-urethral at the prostatic level (one case), recto-urethral at the bulbar level (6cases), and recto-urethral at the distal urethra (one case). Moreover, congenital recto-vaginal (one case) and recto-cutaneous (one case) fistulas were also observed in this work. Augmented pressure colostogram and/or voiding cysto-urethrogram had delineated the fistulous tract well. Karsten et al. [24] reported 16 recto-urethral fistulas and 4 cases with recto-vesical fistula by using the voiding cysto-urethrogram. Thomeer et al. [25] examine neonates with ano-rectal malformations, and they found 9 cases with recto-bulbar urethral fistula, 6 cases with recto-prostatic urethral fistula, one case with bladder neck fistula, and one neonate with recto-perineal.
Cloacal cystic anomalies were associated with ano-rectal malformations in our study in 2 cases [26, 27]. Vesico-ureteric reflux was found in 3 cases. Cloacal anomalies and vesico-ureteric reflux are frequently associated with ano-rectal malformations [26,27,28]. Acquired perineal fistula was reported in 4 cases in this study. Usually, perineal fistula presented in the older age group after perineal suppuration. All perineal fistulas were low and treated by fistulectomy as seen in the literature [29].
This work included another case of iatrogenic infantile fistula which is urethro-cutaneous fistula. Iatrogenic urethro-cutaneous fistulas were reported as congenital fistula [30] or as a complication after the repair of hypospadias [31].
This study has limitations in the form of a small number of patients, not including other fistulas such as GIT or vascular fistula, and only conventional X-ray and fistulogram are used, not computed tomography (CT) nor magnetic resonance (MR).