A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria ^☆

Abstract

Introduction and importance

Acquired tracheo-oesophageal fistula (TOF) is a rare complication of intubation or traumas, either blunt or penetrating. In a penetrating chest trauma, the closure of TOF can be challenging and requires a unique technique. A flap can and intra-tracheal tube can also be used. We present this case to demonstrate a unique late presentation of TOF and the unique approach that was used.

Case presentation

A patient presented with a large TOF caused by shrapnel, and was surgically managed after two months of the injury by using a smaller intra-tracheal tube, and using an oesophageal wall flap to close the tracheal defect and intercostal muscle flap was used for the oesophageal wall repair. The postoperative intrathoracic oesophageal leak was successfully treated conservatively.

Clinical discussion

Although the surgery could not be conducted until 2 months after the injury, the approach used was successful and the patient was able to resume his normal life after the surgery. The flap from the oesophagus and intercostal muscles and using a smaller tracheal tube successfully repaired the TOF with minimum stress on the suterings, and the conservative approach for the leak was also successful.

Conclusion

Traumatic TOF management can be complicated, but we speculate that using a smaller tube with the conservative management of the complications was ideal for the TOF acquired from a shrapnel.

Highlights

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  Acquired tracheo-oesophageal fistula (TOF) can be caused by trauma.

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  The closure of TOF can be difficult and requires unique technique.

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  Using a smaller intra- tracheal tube with a flap from oesophageal wall can help in TOF closure in the tracheas.

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  Oesophagus wall injury from the shrapnel was managed by intercostal muscles.

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  Post-operative oesophageal leak can be managed conservatively.