Acquired tracheoesophageal fistula repair, due to prolonged mechanical ventilation, in patient with double incomplete aortic arch

Abstract

We report a case of the repair of an acquired benign tracheoesophageal fistula (TEF) after prolonged mechanical invasive ventilation. Patient had an unknown double incomplete aortic arch determining a vascular ring above trachea and esophagus. External tracheobronchial compression, caused by the vascular ring, increasing the internal tracheoesophageal walls pressure determined by endotracheal and nasogastric tubes favored an early TEF development. The fistula was repaired through an unusual left thoracotomy and vascular ring dissection. TEFs are a heterogeneous group of diseases affecting critically ill patients. Operative closure is necessary to avoid further complications related to this condition. Pre-operative study is mandatory to plan an adequate surgical approach.

Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

“…There are many causes for acquired TEFs including prolonged or ill-fitting tracheostomy use, esophageal foreign bodies or button batteries, corrosive ingestion, iatrogenic injuries following tracheostomy or endotracheal intubation, and erosion due to airway or esophageal stents. [10][11][12][13][14][15][16][17][18][19][20][21] These acquired fistulas can range in size from millimeters to several centimeters and can occur at any point along the trachea or bronchi, which creates unique challenges in determining an optimal surgical approach. While small, narrow fistulas may be approached endoscopically, 9,20,[22][23][24][25] larger fistulas will require an open procedure.…”

“…While small, narrow fistulas may be approached endoscopically, 9,20,[22][23][24][25] larger fistulas will require an open procedure. A variety of different techniques have been reported including ligation with division via transcervical or thoracotomy approach, 3,8,18,21 esophageal transection and patching through a thoracotomy, 16,19 tracheal resection with primary esophageal closure, 17,26 and esophageal diversion or replacement. 7,17,27 While these surgical techniques can be successful in repairing or bypassing a complex TEF, they can be technically demanding and each have risks for post-operative complications such as tracheal or esophageal stenosis, recurrent laryngeal nerve injury with potential need for tracheostomy, tracheal pouch formation, tracheomalacia, and surgery-related mortalities.…”

“…TEFs can also be found outside of the neonatal period, either due to acquired causes or later recognition of congenital H‐type fistulas. There are many causes for acquired TEFs including prolonged or ill‐fitting tracheostomy use, esophageal foreign bodies or button batteries, corrosive ingestion, iatrogenic injuries following tracheostomy or endotracheal intubation, and erosion due to airway or esophageal stents 10–21 . These acquired fistulas can range in size from millimeters to several centimeters and can occur at any point along the trachea or bronchi, which creates unique challenges in determining an optimal surgical approach.…”