Tracheo-Esophageal fistula and laryngotracheal stenosis following prolonged endotracheal intubation
18 April 2018 (online)
Tracheoesophageal fistula (TEF) is a pathological entity characterized by the presence of an abnormal connection between the trachea & the esophagus. Apart from the congenital form, acquired TEF most commonly occurs following prolonged intubation incidence being 0.3 to 3% in patients with prolonged intubation. Most cases of TEF due to prolonged intubation are associated with laryngotracheal stenosis (LTS). Management of TEF and LTS in a single sitting is challenging.
Material and Methods:
60 patients who presented with LTS in the department of Otorhinolaryngology at the J.S.S Medical College and Hospital, Mysore, India during of period of January 2013 -December 2016. Out of 60 patients 7 (11.7%) had TEF. Five patients underwent TEF repair with T-tube insertion and 1 patient underwent only TEF repair. All patients were followed up for 6 – 10months.
Here we present a series of seven cases of TEF following prolonged intubation associated with LTS wherein, five patients were males and two were females. The age group of the patients ranged from 22 to 60 years; mean age being 34 years. Duration of intubation ranged between 12 to 20 days with a mean of 14.85 days. Five patients underwent TEF repair with T-tube insertion and 1 patient underwent only TEF repair. All patients were followed up for 6 – 10months. All 5 patients with T-tube were removed in 4 to 6 months' time.
All patients presenting with breathing difficulty following prolonged intubation should be investigated for TEF along with LTS. So high index of clinical suspicion is required for early diagnosis and treatment of TEF presenting with LTS.
Tracheoesophageal fistula, laryngotracheal stenosis, prolonged intubation.