Tracheoesophageal Fistulas Unrelated to Malignancy: A Case Series

Abstract

Tracheoesophageal fistula (TEF) is a rare, pathological connection between the trachea and esophagus that can be acquired or congenital. Acquired TEF typically occurs due to iatrogenic injuries. There is often a delay in diagnosis due to the rare nature of this condition. These patients have a very high mortality rate, and a multidisciplinary strategy is required for the management of TEF involving specialists from interventional pulmonology, gastroenterology, and thoracic surgery. The clinical features, diagnosis, and management of nine patients with TEF are covered in this article. Eight patients were diagnosed with acquired TEF and one with a recurrence of congenital TEF. Our experience shows that, when patients develop TEF, it is usually a terminal event, and major procedures cannot be tolerated due to multiple comorbidities and ventilator dependency. Thus, these patients are managed with palliative treatment to improve their quality of life. Although surgical intervention is the gold standard for patients with acquired TEF, it is considered feasible in very few cases, so this article focuses primarily on interventional therapy rather than surgery.

Keywords: benign disease; bronchoscopy; endoscopy; intubation; tracheoesophageal fistula.

Figure 1. Infected tracheal stent (see arrow) with the proximal portion partially in the esophagus through the tracheo-esophageal fistula

Figure 2. Esophageal stent visible through the large TE fistula (arrow showing the edge of the fistula)

The tracheostomy tube is also visible with the cuff deflated.