Post-Intubation Tracheoesophageal Fistula: Surgical Management by Complete Cervical Tracheal Transection

Abstract

We report successful surgical management of post-intubation tracheoesophageal fistula (TEF) in an adult patient requiring long-term mechanical ventilation. A complete tracheal transection without tracheal resection, via an anterior cervical approach, followed by direct closure of tracheal and esophageal defect, and interposition of muscle flap between the suture lines and tracheal reconstruction was performed. In selected cases, this surgical procedure may be a viable alternative to traditional techniques used to treat post-intubation TEF via the anterior or lateral cervical approach.

Keywords: alternative technique; surgery; tracheoesophageal fistula.

Fig. 1. (A) Endoscopic visualization of the TEF (black arrows) from the trachea using flexible bronchoscopy. (B and C) Axial and sagittal chest computed tomography scans showing the TEF (red asterisk) at the level of the thoracic inlet. TEF: tracheoesophageal fistula; T: trachea

Fig. 2. Intraoperative view of the TEF. (A) The retracted distal tracheal stump allows the identification of the esophageal (yellow arrow) and tracheal (white arrow) defects. (B) Closure of the esophageal defect with interrupted sutures (yellow arrow). TEF: tracheoesophageal fistula; tt: tracheal tube

Fig. 3. Surgical procedure drawing. (A) Retraction of the distal tracheal stump after complete tracheal transection. (B and C) Direct closure of the esophageal and tracheal defects. (D) Tracheal reconstruction after mobilization of muscle flap.