Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Abstract

Forty-four collected cases of ulcerative tracheo-oesophageal fistula following tracheostomy and assisted ventilation are reviewed. The condition followed this form of treatment in 05% of cases and must be distinguished from fistulae caused by accident or surgery, and also from laryngotracheal paralysis or dysfunction. The symptomatology, diagnosis, and treatment are discussed in detail. Spontaneous cure of fistulae is rare, and operative closure should be the aim. In one patient in six, surgical closure is excluded by rapid death. When surgery is possible its timing requires critical judgement. Factors requiring assessment are the condition of the patient and of the tissues around the fistula, the necessity to continue assisted ventilation, and the ability to control nutrition, tracheal aspiration from the mouth or stomach, and pulmonary infection. The mortality of those who did not die too rapidly to receive treatment was 61 % without surgery and 45-5% with surgery.

Acquired tracheoesophageal fistula after prolonged mechanical ventilation

“…Overall, acquired TEFs in the US are rare. Harley, in 1972, reported the incidence of TEFs in patients on ventilatory assistance at 0.5% [3]. Malignant TEFs are usually a complication of esophageal cancers Á the incidence reported at 5% in one report [4].…”

Management of an acquired tracheoesophageal fistula with a fascial free flap

“…9 Isolated TEFs, in the setting of a mechanically ventilated patient, are described most frequently in patients after tracheostomy and are considered an iatrogenic injury related to the procedure. 1,5,8 The reported risk of posterior tracheal wall injury during placement of a percutaneous dilational tracheostomy is slightly higher than with standard tracheostomy. 13 Percutaneous dilational tracheostomy (PDT), first described by Sheldon in 1955, is a technical modification of the bedside tracheostomy with a low reported rate of complications.…”

“…Fistulae noted above this location, at the level of a tracheostomy stoma, are believed to be secondary to local surgical trauma occurring at the time of tracheostomy. 1,5,8 The specific treatment options vary and are dictated by the patientÕs overall medical condition and the type of defect. We present a case of a benign acquired TEF treated with a forearm fascial free tissue reconstruction.…”

Post-tracheostomy tracheo-oesophageal fistula – an unusual presentation

“…A rare but characteristic sign of TOF is the rapid onset of severe epigastric distension, which may be rhythmical with each positive pressure breath from the ventilator. [5] This usually occurs when the TOF is situated below the level of the cuff. This can result in massive abdominal distension with devastating consequences.…”