A rare case of adult acquired tracheo-oesophageal fistula with sub-glottic stenosis for corrective surgery- an anesthetic challenge

Abstract

Acquired trachea-esophageal fistula (TEF) is a rare condition in adults and causative factors include malignancy, trauma and various iatrogenic causes. The important causative factor of TEF in our case was percutaneous tracheostomy. The normal protective laryngeal reflexes are lost in TEF due to the patent tract from the airway to the upper gastrointestinal tract. The TEF poses a challenge for the surgeon and the anaesthesiologist, as the fistula lies in close proximity to oesophagus, trachea, upper mediastinal contents and large blood vessel. Here we present a rare case of anesthetic management of a 26 year old male patient with complaints of regurgitation of part of swallowed food particles through an in-situ tracheostomy tube since two years.

Keywords: Acquired TEF; Montgomery T tube; Sub-glottic stenosis; Tracheostomy tube.

[Table/Fig-1]:

Patient

[Table/Fig-2]:

Chest x-ray showing level of tracheostomy tube

[Table/Fig-3]:

Level of sub glottis stenosis

[Table/Fig-4]:

Fixation of sterile flexometallic tube,

[Table/Fig-5]:

Intermittent removal of flexometallic tube for closure of fistula,

[Table/Fig-6]:

Diagrammatic positioning of Montgomery T-tube

[Table/Fig-7]:

Post insertion of Montgomery T-tube, upper end occluded with foley’s catheter