{Reference Type}: Case Reports
{Title}: Acquired tracheoesophageal fistula repaired with one-stage surgery without tracheal resection using lateral cervical approach, a case report.
{Author}: Abughararah T;Adeen AA;Althagafi Z;
{Journal}: Int J Surg Case Rep
{Volume}: 119
{Issue}: 0
{Year}: 2024 Jun 27
暂无{DOI}: 10.1016/j.ijscr.2024.109591
{Abstract}: <B>BACKGROUND: </B>Acquired non-malignant tracheoesophageal fistula (TEF) is a rare pathological connection between the trachea and esophagus caused primarily by iatrogenic injuries. Cuff-related injury causes pressure necrosis of the tracheoesophageal walls, often due to the overinflation of tubes.<BR><B>METHODS: </B>A 29-year-old male who was mechanically ventilated for 3 months developed TEF after weaning from ventilation. The patient had severe sepsis, right lower lobe pneumonia, and parapneumonic effusion requiring multidisciplinary approach management. Preoperative measures were applied, including control of sepsis, nutritional support, stomach decompression, lung physiotherapy, placement of the cuff distal to the fistula, and weaning from ventilation. We performed a one-stage TEF repair with an interposition strap muscle flap using the lateral approach.<BR><B>CONCLUSIONS: </B>The surgical approach greatly depends on the fistula location, size, and concomitant tracheal stenosis. Large TEFs or tracheal stenosis are repaired with segmental tracheal resection and anastomosis. Small TEFs and a normal trachea are repaired with direct closure of tracheal and esophageal defects, which can be performed through lateral or anterior cervicotomy.<BR><B>CONCLUSIONS: </B>This case emphasizes the importance of a multidisciplinary approach, preoperative management, and meticulous surgical technique in the management of acquired TEF.