Double tracheoesophageal fistula after prolonged intubation during COVID-19: surgical treatment by colonic transposition in the retrosternal space

Abstract

This is a patient with 2 tracheoesophageal fistulas following prolonged intubation due to COVID-19 with severe evolution and indication for surgical treatment due to failure of endoscopic treatment. Patient in a long hospital stay, unable to eat an oral diet, malnourished, chronic cough, developing persistent pneumonia due to recurrent salivary bronchoaspiration. The case was treated by complex surgical intervention consisting of proximal and distal partial esophagectomy with reconstruction of food transit by colonic bypass in the anterior mediastinum, resection and tracheal reanastomosis. The final result was good, with the patient being discharged from the hospital on a restored oral diet and free spontaneous breathing. The resolution of an extremely serious case through a complex and exceptional surgical approach, which imposed enormous challenges in pre-operative preparation and detailed therapeutic planning, with single-stage surgical action by two surgical teams (Digestive System Surgery and Thoracic Surgery).