Abstract
Tracheoesophageal fistulas (TEF) present a perioperative management challenge. A 62 year-old man with esophageal carcinoma presented with a large tracheoesophageal fistula extending most of the trachea. Previously, the patient had two overlapping esophageal and one tracheal stent placed, but he developed progressive tracheal disruption due to esophageal stent perforation near the level of the cricoid. This case describes the anesthetic management of tracheal stent placement for an expanding TEF. Management included a spontaneous breathing inhalation induction followed by ventilation through a supraglottic device—laryngeal mask airway (LMA). Finally, during rigid bronchoscopy, a combination of bag ventilation and jet ventilation was utilized.
Highlights
The presence of a large tracheoesophageal fistula (TEF) poses an airway management challenge to the anesthesiologist
The TEF was managed by an outside institution with two sequential overlapping esophageal stents and subsequently one uncovered selfexpanding metallic tracheal stent (18 mm) due to progressive extension of the fistula
The fistula was mostly covered by the noted esophageal stents; the tracheal stent had migrated into the right mainstem bronchus
Summary
The presence of a large tracheoesophageal fistula (TEF) poses an airway management challenge to the anesthesiologist. The risks of anesthesia for adults and children with TEF overlap in many ways, but what is not known is the best technique for ventilating a patient with a large TEF [12]. The TEF was managed by an outside institution with two sequential overlapping esophageal stents and subsequently one uncovered selfexpanding metallic tracheal stent (18 mm) due to progressive extension of the fistula.
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