Anesthetic management of congenital broncho-esophageal fistula in an adult

Abstract

Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.

Repair of a three-way congenital bronchoesophageal fistula in an adult patient: a case report

“…Proper anesthetization is critical before the operation. To prevent gastric distention and loss of ventilation volume, the cuff of the tracheal intubation should be placed under the fistula, or the dual-lumen endotracheal intubation should be used to provide unilateral lung ventilation and avoid the fistula [ 4 ]. However, bilateral bronchial defects found in the present case made it impossible to perform traditional intubation.…”

Silicone tracheobronchial stent: A rare cause for bronchoesophageal fistula and distortion of airway anatomy

“…In case of thoracotomy from the diseased side, the bronchial lumen of DLT may be inserted into the opposite healthy main bronchus to ensure isolation and ventilation of healthy lung while avoiding instrumentation of fistulous bronchus [ Table 1 ]. [ 9 10 11 12 13 ] Alternatively, a single lumen ETT may be used on the same principle by advancing it into the desired main bronchus depending on the side of thoracotomy approach. A large more distal fistula may be occluded using Fogarty catheter.…”

Delayed presentation of post tuberculous broncho oesophageal fistula in an adult: Perioperative anaesthetic management

“…The aim during induction of anaesthesia is to avoid gas flow through the fistula which can cause gastric distension and impaired ventilation. [ 3 ] Positive pressure ventilation should be avoided. Spontaneous ventilation should be maintained during induction until gentle ventilation by mask provides an effective gas exchange.…”

“…Double lumen intubation is required which protects the contralateral lung from contamination and provides the ability to ventilate it without applying positive pressure to the fistula. [ 3 ] Keeping the same in mind, rapid sequence induction was planned as insertion of DLT under spontaneous ventilation is difficult. Once placed, the diseased lung was isolated and kept collapsed.…”