COMPLICATIONS OF TRACHEOESOPHAGEAL FISTULAS

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tracheoesophageal fistula (TEF) is a known but serious complication of prolonged intubation. There are various clinical consequences associated with TEF and achieving successful repair can be difficult. CASE PRESENTATION: This 61 year-old female history multiple medical problems who presented initially after being found down outside. She was hypothermic on admission required active rewarming. intubated for hypoxic hypercapnic respiratory failure. Her hospital course complicated by septic shock due to Klebsiella Pseudomonas pneumonia, which Tracheostomy attempted day 20 intubation however 1cm seen in the subglottic region procedure aborted. had repeat bronchoscopy as she developed constant leak volume loss ventilator along increased gastric secretions via endotracheal tube. showed that size therefore tracheostomy tube surgically placed cuff beyond level TEF. soon episodes severe distress dislodged into esophagus further increasing fistula, now extending from just below vocal cords slightly mid-trachea. Endoscopic gastrointestinal over-the-scope-clipping (OTSC) failed. eventually underwent left sternocleidomastoid flap posterior membrane trachea primary esophagus. subsequently veno-venous Extracorporeal oxygenation (V-V ECMO) during procedure. then hemoptysis bleeding around surgical site causing obstruction blood clots distal given tranexamic acid nebulizers an tip end about 1 cm above carina. currently still intensive care unit, off ECMO, recovering. DISCUSSION: Management benign TEFs includes either muscle flaps or full thickness skin grafts. Surgical complications include wound dehiscence, recurrent fistulas, tracheal stenosis 11% mortality rate. Patients requiring intervention may benefit V-V ECMO preoperatively allow ultra protective ventilation low airway pressure healing. Those not candidate surgery receive esophageal stenting. A newer OTSC promising results, our patient unfortunately CONCLUSIONS: uncommon In era COVID-19 there has been rise reported cases such case demonstrates severity complications. REFERENCE #1: DJ;, Reed MF;Mathisen. "Tracheoesophageal Fistula.” Chest Surgery Clinics North America, U.S. National Library Medicine, 13 May 2003 #2: Drumpt, Anne S. van, et al. "Surgery Large Fistula Using Membrane Oxygenation.” Journal Thoracic Disease, AME Publishing Company, 11 Sept. 2017 #3: Puma, Francesco, Perioperative Post-Intubation Fistula: Series Analysis.” 22 Feb. DISCLOSURES: No relevant relationships Imene Boumaza, source=Web Response Keerthana Keshava, Nourhan Kika, Nisha Patel,