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Negaresh M, Hoseininia S, Samadi Takaldani AH, Feyzi‐Khankandi I, Mohammadzadeh Germi B, Ghobadi H. Implanting jejunostomy tube as conservative management of tracheoesophageal fistula in a COVID-19 patient. Clin Case Rep 2021; 9:e05151. [PMID: 34917369 PMCID: PMC8643485 DOI: 10.1002/ccr3.5151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022] Open
Abstract
A 44-year-old woman with Behcet's disease experienced a severe COVID-19 infection and developed a tracheoesophageal fistula. Despite the need for surgical treatment, she did not consent. Therefore, the patient underwent supportive treatment with a jejunostomy tube. After four weeks of follow-up, the fistula was repaired spontaneously.
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Affiliation(s)
- Mohammad Negaresh
- Department of Internal MedicineSchool of MedicineArdabil University of Medical SciencesArdabilIran
| | - Saeed Hoseininia
- Department of Internal Medicine (Pulmonary Division)School of MedicineArdabil University of Medical SciencesArdabilIran
| | - Ali Hossein Samadi Takaldani
- Department of Internal Medicine (Pulmonary Division)School of MedicineArdabil University of Medical SciencesArdabilIran
| | - Iraj Feyzi‐Khankandi
- Department of SurgerySchool of MedicineArdabil University of Medical SciencesArdabilIran
| | | | - Hassan Ghobadi
- Department of Internal Medicine (Pulmonary Division)School of MedicineArdabil University of Medical SciencesArdabilIran
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2
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Tracheoesophageal Fistula in a COVID-19 Ventilated Patient: A Challenging Therapeutic Decision. Case Rep Surg 2021; 2021:6645518. [PMID: 33833892 PMCID: PMC8014238 DOI: 10.1155/2021/6645518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/22/2022] Open
Abstract
COVID-19 associated severe respiratory failure frequently requires admission to an intensive care unit, tracheal intubation, and mechanical ventilation. Among the risks of prolonged mechanical ventilation under these conditions, there is the development of tracheoesophageal fistula. We describe a case of a severe COVID-19 associated respiratory failure, who developed a tracheoesophageal fistula. We hypothesized that one of the mechanisms for tracheoesophageal fistula, along with other local and general risk factors, is the local infection due to the location of the virus itself in the tracheobronchial tree. The patient was managed successfully with surgical intervention. This case highlights the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and suggests a management strategy.
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Alkrekshi A, Bukamur H. Iatrogenic esophageal and tracheal perforation with tracheoesophageal fistula following emergency intubation. Clin Case Rep 2021; 9:588-589. [PMID: 33489224 PMCID: PMC7813096 DOI: 10.1002/ccr3.3552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Iatrogenic tracheoesophageal fistula (TEF) through direct penetration of esophageal and tracheal walls is exceedingly rare. Body tissues sealing around the tube may result in delayed development of respiratory complications and diagnosis. Pneumomediastinum and pneumothorax may be absent. Maintaining the airway through TEF until tracheostomy resulted in a satisfactory outcome.
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Affiliation(s)
- Akram Alkrekshi
- Department of Internal MedicineThe MetroHealth System Campus of Case Western Reserve UniversityClevelandOHUSA
| | - Hazim Bukamur
- Department of Pulmonary and Critical Care MedicineTexas Tech University Health Science CentreLubbockTXUSA
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Baig SN, Herrera SJ, Makinde D, Abaleka FI, Akhter S. A Fatal, Post-Intubation, Tracheoesophageal Fistula. Cureus 2020; 12:e9014. [PMID: 32775094 PMCID: PMC7405977 DOI: 10.7759/cureus.9014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Despite the use of safer tubes with high-volume, low-pressure cuffs, post-intubation injury is still the leading cause of benign, acquired, tracheoesophageal fistula (TEF). Cuff pressure, which is their primary pathogenetic driver, is not routinely monitored as a quality metric. To highlight the devastating consequences, we report this case of a fatal, iatrogenic fistula in a 64-year-old Asian male. He had undergone tracheostomy due to amyotrophic lateral sclerosis (ALS) and had a series of hospitalizations due to recurrent episodes of pneumonia. A TEF was eventually diagnosed to be the underlying cause. Esophageal stenting was ineffective. We intend to present teaching points aimed at reducing the risk of TEF in ventilator-dependent patients.
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Affiliation(s)
- Sher N Baig
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Stefanie J Herrera
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Deborah Makinde
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Fuad I Abaleka
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Shahnaz Akhter
- Research, Richmond University Medical Center, Staten Island, USA
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Dhiwakar M, Ronen O, Supriya M, Mehta S. Surgical repair of mechanical ventilation induced tracheoesophageal fistula. Eur Arch Otorhinolaryngol 2019; 277:323-331. [PMID: 31705278 DOI: 10.1007/s00405-019-05723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation. METHOD Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included. RESULTS A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA. CONCLUSION In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India.
| | - Ohad Ronen
- Galilee Medical Center, Bar-Ilan University, Safed, Israel
| | | | - Shivprakash Mehta
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India
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Green MS, J. Mathew J, J. Michos L, Green P, M. Aman M. Using Bronchoscopy to Detect Acquired Tracheoesophageal Fistula in Mechanically Ventilated Patients. Anesth Pain Med 2017; 7:e57801. [PMID: 29430408 PMCID: PMC5797673 DOI: 10.5812/aapm.57801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/14/2017] [Accepted: 06/06/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF. Angioedema of the airway is a rare but potentially devastating complication of angiotensin converting enzyme inhibitors (ACE-I) that could further add insult to the tracheal mucosa, predisposing to an acquired TEF. Case Presentation An elderly woman with multiple comorbidities and requiring mechanical ventilation, developed angioedema following intake of ACE inhibitor for hypertension. The ensuing airway edema made weaning off mechanical ventilation difficult. After repeated attempts at extubation, tracheostomy was performed. With the loss of airway after tracheostomy, the possibility of TEF was considered given her multiple risk factors and intra-operative findings of the tracheal mucosa. Conclusions While it may be difficult to predict who will actually develop a TEF, it is prudent to identify those at risk and take precautionary measures to prevent one. Emphasis should be placed on daily endotracheal cuff manometric pressure check to prevent ischemic changes of the tracheal mucosa resulting from high cuff pressures. Also, bronchoscopy could be used after extubating susceptible patients to detect an acquired TEF.
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Affiliation(s)
- Michael S. Green
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
- Corresponding author: Michael S. Green, DO, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102. Tel: +01-2157627922, Fax: +01-2157628656, E-mail:
| | - Johann J. Mathew
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Lia J. Michos
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Parmis Green
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Mansoor M. Aman
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
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Arkuszewski P, Barzdo M, Ostrowski S, Szram S, Berent J. Left atrio-esophageal fistula of a possibly iatrogenic aetiology. Forensic Sci Int 2015; 252:e1-5. [PMID: 25952079 DOI: 10.1016/j.forsciint.2015.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/04/2015] [Accepted: 03/18/2015] [Indexed: 11/17/2022]
Abstract
The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube.
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Affiliation(s)
- Piotr Arkuszewski
- Department of Forensic Medicine, Medical University of Lodz, Poland.
| | - Maciej Barzdo
- Department of Forensic Medicine, Medical University of Lodz, Poland
| | | | - Stefan Szram
- Department of Medico-Legal and Insurance Certification, Medical University of Lodz, Poland
| | - Jarosław Berent
- Department of Forensic Medicine, Medical University of Lodz, Poland
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Cohen-Atsmoni S, Tamir A, Avni Y, Priel IE, Roth Y. Endoscopic Occlusion of Tracheoesophageal Fistula in Ventilated Patients Using an Amplatzer Septal Occluder. Indian J Otolaryngol Head Neck Surg 2015; 67:196-9. [PMID: 26075179 DOI: 10.1007/s12070-015-0842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 11/29/2022] Open
Abstract
Acquired tracheoesophageal fistula (TEF) is a challenging, life threatening condition. It most commonly appears in critically ill patients requiring prolonged mechanical ventilation, who cannot withstand open neck or chest surgery. An endoscopic technique could be better tolerated by these patients. We present our experience using a cardiac Amplatzer ASD septal occluder for an endoscopic TEF repair in ventilation-dependent patients. Two high risk patients underwent the procedure under general anesthesia and close respiratory monitoring. In one patient the device was inserted through the trachea and in the other through the esophagus. In both cases fistula closure was achieved for different periods of time allowing the patients a temporary relief of symptoms. The procedure was well tolerated by the patients, and no significant adverse effect documented. The technique was successful as a temporary solution for unstable patients with TEFs and should be considered as a treatment modality for similar patients.
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Affiliation(s)
- Smadar Cohen-Atsmoni
- Department of Otolaryngology-Head & Neck Surgery, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
| | - Akiva Tamir
- Department of Pediatric Cardiology, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Yona Avni
- Department of Gastroenterology, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Israel E Priel
- Department of Pulmonary Medicine, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head & Neck Surgery, The Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
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9
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Complications Associated with the Use of the Amplatzer Device for the Management of Tracheoesophageal Fistula. Ann Am Thorac Soc 2014; 11:1507-9. [DOI: 10.1513/annalsats.201408-352le] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Akaraviputh T, Angkurawaranon C, Phanchaipetch T, Lohsiriwat V, Nimmanwudipong T, Chinswangwatanakul V, Metasate A, Trakarnsanga A, Swangsri J, Taweerutchana V. Platysma myocutaneous flap interposition in surgical management of large acquired post-traumatic tracheoesophageal fistula: A case report. Int J Surg Case Rep 2014; 5:282-6. [PMID: 24727740 DOI: 10.1016/j.ijscr.2014.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acquired post-traumatic tracheoesophageal fistula (TEF) is an uncommon entity requiring early diagnosis. Among the many strategies in surgical management, we report a case successfully treated with a single-stage tracheal resection and esophageal repair with platysma myocutaneous interposition flap. PRESENTATION OF CASE A 24-year-old man had a motor vehicle accident with head injury and cerebral contusion who required mechanical ventilation support. Three weeks later, he developed hypersecretion, and recurrent episodes of aspiration pneumonia. The chest computed tomography, esophagogastroduodenoscopy, and bronchoscopy revealed a large TEF diameter of 3cm at 4.5cm from carina. Single-stage tracheal resection with primary end-to-end anastomosis and esophageal repair with platysma myocutaneous interposition flap was performed. A contrast esophagography was done on post-operative day 7 and revealed no leakage. He was discharged on post-operative day 10. Esophagogastroduodenoscopy at 1 month revealed patient esophageal lumen. At present he is doing well without any evidence of complications such as esophageal stricture or fistula. DISCUSSION There are many choices of myocutaneous muscle flaps in trachea and esophageal closure or reinforcement. The platysma myocutaneous flap interposition is simple with the advantage of reduced bulkiness. Concern on the vascular supply is that flap should be elevated with the deep adipofascial tissue under the platysma to ensure that the flap survival is not threatened. CONCLUSION The treatment of acquired TEF with platysma myocutaneous flap is an alternative procedure for a large uncomplicated TEF as it is effective, technically ease, minimal donor site defect and yields good surgical results.
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Affiliation(s)
- Thawatchai Akaraviputh
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Chotirot Angkurawaranon
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Teerawit Phanchaipetch
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Visnu Lohsiriwat
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanyadej Nimmanwudipong
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Asada Metasate
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Voraboot Taweerutchana
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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12
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Kim MS, Koh EJ, Choi HY. Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes - A Case Report -. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.2.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Myeong Soo Kim
- Department of Neurosurgery, Dong Kang Medical Center, Ulsan, Korea
| | - Eun Jeong Koh
- Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School/Hospital, Jeonju, Korea
| | - Ha Young Choi
- Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School/Hospital, Jeonju, Korea
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13
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Peters JH, Hoogerwerf N. Prehospital endotracheal intubation; need for routine cuff pressure measurement? Emerg Med J 2012; 30:851-3. [DOI: 10.1136/emermed-2012-201388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-67. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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15
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Endoscopic Approach to Tracheoesophageal Fistulas in Adults. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2008. [DOI: 10.1016/j.tgie.2008.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Oksuz H, Senoglu N, Zencirci B, Ezberci M, Yuzbasioglu MF. Pneumothorax, pneumomediastinum, tracheo-esophageal fistula presenting with endotracheal intubation in post-cesarean period: A case report. CASES JOURNAL 2008; 1:134. [PMID: 18759991 PMCID: PMC2543003 DOI: 10.1186/1757-1626-1-134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 08/29/2008] [Indexed: 11/10/2022]
Abstract
Background The non-malignant, acquired tracheoesophageal fistulas (TEF), resulting from tracheal intubation are usually iatrogenic lesions. Tracheal lesions resulting from intubation may occur and pneumomediastinum, pneumothorax or subcutaneous emphysema may develop due to the stream of air. Case Presentation We present a-39-year old, Caucasian patient, developing severe hypoxia fallowing cesarean section under general anesthesia. The findings of the patient were diffuse subcutaneous emphysema; together with pneumothorax and pneumomediastinum TEF was diagnosed in the patient by bronchoscopy and eusophagoscopy performed due to cough and difficulty in swallowing developing after extubation. Conclusion It is important to the clinicians to be aware of the TEF can be accompanied to the traumatic intubation and urgent endoscopy or water-soluble contrast radiography may be prudent.
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Affiliation(s)
- Hafize Oksuz
- Kahramanmaras Sutcu Imam University Medical Faculty, Department of Anesthesiology and Reanimation, Kahramanmaras, Turkey.
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