This was a case of a 65 year old female who came to our department with dysphagia for Barium Swallow.
Upon doing the investigation, a tracheoesophageal fistula was detected and the patient was rushed to the casulaty for further management.
The patient had probably developed the fistula due to pressure necrosis by a tracheostomy tube as she had given history of being applied a trachestomy tube for quite some time.
X-Ray Images
DISCUSSION
A tracheoesophageal fistula is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as alaryngectomy.
Causes
Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges during the third week of embryological development.
A fistula, from the Latin meaning ‘a pipe,’ is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-esophageal fistula it runs between the trachea and the esophagus. This connection may or may not have a central cavity; if it does, then food within the esophagus may pass into the trachea (and on to the lungs) or alternatively, air in the trachea may cross into the esophagus.
TEF can also occur due to pressure necrosis by a tracheostomy tube in apposition to a nasogastric tube (NGT).
Associations
Babies with TEF or esophageal atresia are unable to feed properly. Once diagnosed, prompt surgery is required to allow the baby to take in food. Few TEF children have problems after surgery, however a number develop feeding difficulties and chest problems. Some TEF babies are also born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities. 6% of babies with TEF also have a laryngeal cleft
Clinical presentation
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. A fistula may also be a the cause of polyhydramnios while in utero.
Treatment
It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Surgical repair is associated with complications, including
- Stricture, due to gastric acid erosion of the shortened esophagus.
- Leak of contents at the point of anastomosis.
- Recurrence of fistula.
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