Tracheocarotid fistula with life-threatening hemorrhage: Report of case

Abstract

Every surgical procedure carries certain potential risks and complications. Perhaps none is as dramatic or as devastating as a delayed, massive hemorrhage caused by a fistula between the trachea and a major vessel following tracheostomy. Exsanguinating hemorrhage from such an injury can occur within seconds. 1 Koerte in 1879 was the first to report such a fatality in a 5-year-old patient who suffered an exsanguinating hemorrhage from a ruptured innominate (brachiocephalic) artery. 2 Schlaepfer in 1924 and Brantigan in 1973 both found that the innominate artery was the vessel most frequently involved in this complication (75%). 1,3 A little-known variant of this problem is involvement of the right common carotid artery. It occurs in approximately 5% of the cases. The purpose of this article is to report a case of near fatal, delayed hemorrhage from a tracheocarotid fistula in a patient with a history of laryngectomy and radiation therapy, its immediate management, and subsequent surgical repair.