Tracheoplasty using the thymus against tracheo‐esophageal fistula due to necrotizing tracheobronchitis in a very low birth weight infant

Abstract

We report a case of a very low birth weight infant treated successfully with tracheoplasty using the thymus against tracheo-esophageal fistula due to necrotizing tracheobronchitis. A baby boy was born at 31 weeks gestation with a birth body weight of 1,230 g. Suddenly on Day 19, his respiration deteriorated, and a flexible bronchofiberscopy showed tracheostenosis, tracheomalacia, and tracheal diverticula. On Day 21, his abdomen became significantly distended, and a flexible bronchofiberscopy showed a tracheo-esophageal fistula due to a rupture of the diverticula. On Day 105, during surgery, we confirmed necrosis of the trachea. Because the lesion was widespread, we used the thymus for tracheoplasty and closure of the tracheo-esophageal fistula. His post-operative course went well, and was discharged at 1 year 9 months of age. Now, 8 years after the operation, although he still needs a T-tube airway management through tracheostomy, he has achieved speech, normal growth and development, and takes regular classes at school. Tracheoplasty using the thymus is thought to be a treatment worth considering when there are no other effective alternative treatments for tracheo-esophageal fistula due to necrotizing tracheobronchitis.

A case of necrotizing tracheobronchitis successfully treated with immunoglobulin

“…Mortality ranges from 45–100% 1 . There are some reports in Japan of NTB after methicillin‐resistant Staphylococcus aureus infection, 2 especially neonatal TSS‐like exanthematous disease (NTED) 3 . To our knowledge, this is the first report of NTB caused by TSST‐1‐producing MSSA.…”

Severe necrotizing tracheobronchitis caused by influenza B and methicillin-resistant Staphylococcus aureus co-infection in an immunocompetent patient

“…Necrotizing tracheobronchitis is a rare clinical entity presented as a necrotic inflammation involving the mainstem trachea and distal bronchi. Most necrotizing tracheobronchitis is usually developed in patients with immunocompromised conditions, like long term mechanical ventilation [ 1 ], low birth weight infant [ 2 ], metastatic carcinoma or use of immunosuppressants [ 3 ]. However, especially in immunocompetent patients, necrotizing tracheobronchitis associated with influenza is very rare.…”