Acquired Tracheoesophageal Fistula Observed after Ventilatory Care

Jung, Yong Hun; Baek, Chong Wha; Park, Jung Won; Woo, Young Cheol; Koo, Gill Hoi

Abstract

Tracheoesophageal fistula (TEF) is a rare disease, which develops as a result of congenital or acquired causes. Moreover, TEF can be caused by an overinflated cuff during respiratory care with a ventilator in the ICU. So, a low pressure high volume cuff is being used to prevent injury of the tracheal mucosa by the endotracheal tube. The use of a low pressure high volume cuff has decreased respiratory complications, but TEF is still being reported. This case concerns a 78-year-olds woman with heart failure. She was hospitalized for hemiarthroplasty because of a right femur fracture. On the day after admission, she had apnea due to heart failure, but recovered on receiving respiratory care by using a ventilator in the ICU. Thereafter, she began to show symptoms such as paroxysmal coughing, vomiting, and aspiration. We investigated using computed tomography, bronchoscopy and esophagography. We observed a 2-3 cm sized fistula along the posterior wall of the trachea. It was located about 10 cm upper side from the carina on bronchoscopy, perfomed was found in the ICU. She was found to have a TEF and was treated surgically. After her symptoms had improved, she was given hemiarthroplasty under epidural anesthesia. However, 4 days after the operation, the TEF relapsed, but was not as severe as it had been previously. She was alert, but ambulation was not possible because of a general weakness due to long-term hospitalization. Even with the danger of aspiration pneumonia, she left the hospital upon her guardian's request. We report upon this clinical experience and include a brief review of the literature.