Acute airway obstruction and tracheal laceration during gastrostomy placement in an infant with tracheoesophageal fistula.

A IRWAY control is one of the most important tenets of anesthetic practice. Asphyxia and tracheal laceration in infants are extremely rare, but life-threatening, complications. Despite many reviews in the literature regarding tracheoesophageal fistula (TEF) and esophageal atresia, 4 no case of tracheal injury following the aberrant passage of a gastrostomy catheter has been reported. The present case describes an unusual case of iatrogenic airway obstruction and tracheal laceration following placement of a gastrostomy catheter in an infant with esophageal atresia. In addition, we discuss a method to prevent this rare iatrogenic injury.