Esophageal and Pharyngeal Injuries Associated with the Use of the Esophageal-Tracheal Combitube

Abstract

The Combitube is a ventilatory device consisting of a twin lumen tube with proximal and distal inflatable cuffs. The major benefit of the Combitube is that its design and function allow for ventilation through non-laryngoscope-assisted insertion into either the trachea, or esophagus. As with any invasive procedure, intubation using the Combitube carries certain risks and potential complications. The majority of complications are relatively minor; however, a rare and serious complication reported primarily in the anesthesiology literature is laceration of the esophagus. This reportedly rare injury is increasingly seen by medical examiners/coroners in the forensic setting. This paper presents a series of three cases of esophageal laceration and a single case of perforation of the hypopharynx associated with the use of the Combitube, while also exploring potential mechanisms of injury. In addition, this work demonstrates the vital role the medical examiner/coroner plays in identifying existing or potential problems with current or emerging medical devices.