Burns and tracheo-oesophageal-cutaneous fistula

Abstract

We report an unusual case of electric burns suffered by a 15-yr-old boy. The patient's neck had come in contact with a high voltage broken electric wire and by reflex he had pulled it away with his right hand. He presented with a tracheo-cutaneous fistula with a right-sided pneumothorax. Emergency airway management included insertion of a tracheostomy tube through the traumatic opening in the neck and insertion of an intercostal tube drain. When the diagnostic endoscopy revealed an externally communicating tracheo-oesophageal fistula, protecting the lower airways from gastrointestinal contamination became a priority. The patient was anaesthetized through the traumatic tracheostomy and a formal low tracheostomy was done below the level of the fistula. The patient then underwent oesophageal reconstruction with a stomach free flap. Tracheo-oesophageal-cutaneous fistula is a rare presentation of electric burns. The anaesthetic management of the emergency difficult airway in any penetrating neck injury can be extremely difficult requiring a carefully planned multi-disciplinary approach.

Tracheal rupture in a child with blunt chest injury

“…The energy liberated by airway rupture can be so great that it has been reported in one case to result in a complex esophageal rupture (19). Any neck injury should prompt the search for associated esophageal injuries (10).…”

“…The diagnosis of airway injuries almost always requires emergency bronchoscopy (7,10,14,24). Emergency bronchoscopy has been recommended in patients with blunt chest trauma to exclude this potentially treatable condition (25), confirm the location of the tear (26) or to plan and guide treatment (19,27).…”

“…Tracheal rupture usually occurs after blunt (9) or penetrating injury to the neck (10). It may present along with other serious injuries (cervical spine, esophagus, craniofacial or cerebral trauma (11)).…”

Elective pre‐operative tracheostomy for head and neck oncoplastic surgery

“…Mishra and colleagues have reported three patients requiring emergency tracheostomies for airway obstruction (3). Emergency tracheostomy under such conditions is a potentially ‘dangerously difficult airway’ situation with often critical and rapidly diminishing ventilation (4). Rather than subject the patient to a difficult airway manoeuvre at the beginning, only to perform a tracheostomy at the end of surgery or face difficulty in the post‐operative period, if we can predict its need in the post‐operative period we would prefer to do the tracheostomy before the surgery.…”