Acquired tracheo-esophageal fistula in adult—a classical case of ‘what not to do’

Abstract

Acquired tracheo-esophageal fistulas (TEFs) are challenging. The most common causes are prolonged intubation, malignancy, and trauma whereas granulomatous infections like tuberculosis are rare. Endoscopic intervention with esophageal or tracheal stenting or clipping is of unproven benefit in the management of such lesions, where surgical repair is almost invariably required. We report a case of a 32-year-old man, with a case of multidrug-resistant pulmonary tuberculosis. He had no history of malignancy or trauma. The patient developed spontaneous TEF probably due to mediastinal lymph node necrosis. Multiple attempts were made using staplers, clips, and atrial septal defect (ASD) device closure but were unsuccessful. The nuanced complication leads to very individualized course of treatment which was optimal for this patient.

A Rare Case of Conservative Management of Multiple Aerodigestive Fistulas in a Patient

“…Our patient with tubercular fistulas did not have clinical features of aspiration, probably because despite having multiple fistulas, the fistulous openings were smaller (less than 5 mm). Therefore, it was decided that the patient did not require primary defect closure with the help of clip, stent etc., either endoscopically or surgically, as is often described in available literature [ 6 , 9 , 10 ]. Endoscopic or surgical correction became necessary if the size of the defect is large (more than 5 mm) or patient has recurrent infection or sepsis because of aspiration.…”