Spontaneous closure of acquired tracheo-oesophageal fistula

Abstract

Acquired tracheo-oesophageal fistulae are uncommon in the paediatric age group. A case of such a fistula secondary to impaction of a button battery is reported below. Prompt management is essential to reduce morbidity and mortality in these cases.

Acquired tracheoesophageal fistula following disc-battery ingestion: Can we watch and wait?

“…Several cases of spontaneous TEF closure after disc-battery ingestion have been reported leading some authors to advocate conservative management with esophageal rest as an alternative to surgical repair [5,[10][11][12][13][14][15]. The current study describes a situation in which spontaneous closure of an acquired TEF was confirmed by endoscopy and esophageal contrast studies after 70 days of esophageal rest.…”

“…Using this metric, acquired TEF has been shown to require a variable time of 28-77 days to close without surgical intervention [8,10,11,15,18]. Conservative management in these reports involve esophageal rest with reflux management, nothing by mouth, and supplemental diets bypassing the esophagus.…”

“…However, immediate surgical intervention can be complicated by high mortality rates, recurrence and the need for multiple procedures [2,8,9]. Thus, several authors have advocated the use of conservative management for acquired TEF following reports of spontaneous closure by secondary intention [5,[10][11][12][13][14][15]. Esophageal rest with reflux precautions, no oral intake, and a diet supplied by gastrostromy, nasogastric, or gastro-jejunal tube feeds, comprise the conservative management in such patients.…”

Fistule œsotrachéale secondaire à l’ingestion d’une pièce de monnaie

“…Dans moins de 1 % des cas, l'extraction endoscopique est impossible avec nécessité d'un geste chirurgical le plus souvent conservateur [1]. Le traitement des fistules oesotrachéale est le plus souvent chirurgical bien qu'un traitement conservateur pour les petites fistules de moins de 15 mm et en absence d'anomalies sous-jacentes a été décrit dans quatre observations depuis 1950 [10][11][12][13]. Dans ce cas, une fermeture spontanée de la fistule oesotrachéale peut s'observer entre 4 à 11 semaines.…”

Battery ingestion in children

“…Exceptionally rare complications include esophageal or aortic perforation [2], tracheo-esophageal fistula [3][4][5][6][7][8][9][10], tracheo-esophageal fistula with a fatal hemorrhagic shock due to erosion of the inferior thyroid vessels [11], severe esophageal bleeding [12], bilateral vocal cord paralysis [13] and heavy metal (lithium, mercury) intoxication [14,15].…”