Tracheal penetration and tracheoesophageal fistula caused by an esophageal self-expanding metallic stent.

Karan Madan,Vijay Hadda,Anant Mohan,Arun Venuthurimilli,Randeep Guleria,Vineet Ahuja

doi:10.1155/2014/567582

Karan Madan, Vijay Hadda + Show 4 more

Open Access

https://doi.org/10.1155/2014/567582

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Abstract

Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.

Highlights

Esophageal self-expanding metallic stents (SEMS) placement has evolved into a first line approach for the palliative relief of dysphagia for patients with advanced esophageal cancer [1]
We describe a patient with recurrent tumorous esophageal SEMS obstruction who developed this complication following third esophageal SEMS placement
Reported major complications associated with the placement of esophageal SEMS include significant bleeding, tumor obstruction, stent migration, airway-esophageal fistulization, gastroesophageal reflux, aspiration pneumonia, and persistent chest discomfort [4]

Summary

Introduction

Esophageal SEMS placement has evolved into a first line approach for the palliative relief of dysphagia for patients with advanced esophageal cancer [1]. Despite the widespread use of esophageal SEMS placement for the numerous previously described indications, delayed prolapse and erosion of esophageal SEMS into the tracheobronchial tree are rarely reported [1, 3,4,5,6]. This uncommon complication can often present as a potentially life threatening emergency. We describe a patient with recurrent tumorous esophageal SEMS obstruction who developed this complication following third esophageal SEMS placement

Case Report

Discussion