Tracheoesophageal fistula
Section snippets
History
The most frequent etiologies for TEF before the 1960s were trauma and granulomatous infection. In 1967 Flege was the first to report TEF caused by cuff-related injury in patients who had been mechanically ventilated [17]. Although the first tracheostomy tube with an inflatable cuff had been described by Trendelenburg in 1871, its widespread use first appeared after the introduction of intermittent positive pressure ventilation for the management of respiratory failure during the Copenhagen
Acquired malignant tracheoesophageal fistula
In patients with esophageal or pulmonary malignancies, the appearance of an esophagorespiratory fistula is a serious complication with a dismal prognosis. Although the more accurate term is malignant esophagorespiratory fistula, the abbreviation TEF is used frequently. If a malignant TEF is untreated, the patient experiences continued tracheobronchial soilage, rapidly develops pulmonary sepsis, and soon dies, with a median survival from time of diagnosis between 1 and 6 weeks [1], [32], [33],
Conclusions
Malignant TEF is a dreadful complication of esophageal and lung cancers. When present, it carries a grim prognosis. Therapy should be prompt and should be aimed at effective palliation. As with all TEFs, the goals of treatment are preventing pulmonary complications and maintaining nutrition. The therapeutic modalities employed for each patient must be tailored to his or her physiologic state. Esophageal bypass can be considered in select individuals with reasonable performance status. In most
Summary
Acquired TEF is a rare complication that can occur from a variety of causes. The most common etiology of nonmalignant TEF is as a complication of intubation with cuff-related tracheal injury. Most patients present with increased secretions, pneumonia, and evidence of aspiration of gastric contents while the patient is on mechanical ventilation. When diagnosed after extubation, the most frequent sign of TEF is coughing after swallowing. A high index of suspicion is required in patients at risk
References (43)
- et al.
Malignant esophagorespiratory fistula: management options and survival
Ann Thorac Surg
(1991) - et al.
Tracheoesophageal fistulas
Ann Thorac Surg
(1993) - et al.
Management of airway trauma. II: combined injuries of the trachea and esophagus
Ann Thorac Surg
(1987) - et al.
Tracheoesophageal fistula after blunt chest trauma
Ann Thorac Surg
(1995) - et al.
Delayed presentation of a tracheoesophageal fistula after blunt chest trauma
Ann Thorac Surg
(1996) - et al.
Acquired benign esophagorespiratory fistula: report of 16 consecutive cases
Ann Thorac Surg
(1990) - et al.
Tracheoesophageal fistula caused by mycobacterial tuberculosis adenopathy
Ann Thorac Surg
(1993) - et al.
Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy
Ann Thorac Surg
(2001) - et al.
Catastrophic complications of the cervical esophagogastric anastomosis
J Thorac Cardiovasc Surg
(1995) - et al.
Benign broncho-esophageal fistula in the adult
Ann Thorac Surg
(2002)