Diagnosis and treatment of tracheoesophageal fistula in tetraplegic-ventilator dependent patient: Case report Tetraplejik-Ventilatör Bağımlı Hastada Trakeaözofageal Fistül Tanı ve Tedavisi: Olgu Sunumu
Anestezi Dergisi, cilt.27, sa.4, ss.304-307, 2019 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 27 Sayı: 4
- Basım Tarihi: 2019
- Doi Numarası: 10.5222/jarss.2019.51523
- Dergi Adı: Anestezi Dergisi
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.304-307
- Anahtar Kelimeler: Tetraplegia, Tracheoesophageal fistula, Tracheostomy
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Acquired tracheoesophageal fistula (TEF) is a rare complication that should not be forgotten in intensive care units (ICUs). Cuff -related tracheal damage is the most common cause among the benign causes of TEF. In this case presentation, the diagnosis and treatment of TEF in a mechanically ventilated tetraplegic patient are discussed. A 45-year-old patient with tetraplegia due to high cervical fracture after a traffic accident was admitted to our ICU from another center where he was followed up with tracheostomy and mechanical ventilation. There was a sudden deterioration in patient's general health condition while he was stable on the 37th day of tracheostomy. Despite adequate ventilation, the patient had CO2 retention. Abdominal distention developed and air was observed in nasogastric drainage tube. Computerized tomography revealed a TEF. Endoscopy was performed for definitive diagnosis. Endotracheal tube cuff that entered into the esophagus was visualized. Tracheostomy cannula was replaced by an endotracheal tube and the balloon was inflated distally from the fistula. The patient underwent a primary repair surgery successfully one week later. In the postoperative period the patient was followed-up with an adjustable tracheostomy cannula. The patient is still being followed up by us in our intensive care unit. Tracheoesophageal fistula is one of the late complications of tracheostomy. Early diagnosis is important to protect the patient from possible fatal pulmonary complications. Increased tracheal secretions, aspiration of gastric contents, ventilation difficulties, abdominal distention or filling of air into the nasogastric tube should alert us for TEF. Tracheoesophageal fistula may not be recognized immediately in ventilator-dependent patients. Adjustable tracheostomy tubes should be considered in special cases.