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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(3):105-108; doi:10.1093/bjaceaccp/mkl019
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Acquired tracheo-oesophageal fistula in adults

Raman Diddee, MB BS FRCA
Specialist Registrar in Anaesthesia and Intensive Care, Newcastle General Hospital Newcastle-upon-Tyne, UK

Ian H Shaw, BSc PhD MB BChir FRCA
Consultant Anaesthetist, Newcastle General Hospital Westgate Road, Newcastle-upon-Tyne NE4 6BE, UK Tel: 0191 256 1398 Fax: 0191 256 3154 E-mail: ianhshaw@aol.com (for correspondence)
The first 150 words of the full text of this article appear below.


Key points

An acquired tracheo-oesophageal fistula bypasses laryngeal protection and leads to repeated pulmonary aspiration.

Cuff-related necrosis and malignancy are currently the major causes.

Diagnosis involves the identification of lesion site and size.

Careful preoperative optimization and weaning from ventilation improves outcome.

Repair requires skills in thoracic and upper-gastrointestinal anaesthesia.

Oesophageal stenting offers palliation for malignant acquired tracheo-oesophageal fistulae.

 

The formation of an acquired tracheo-oesophageal fistula (TOF) is a rare but serious complication of malignancy and trauma. An established patent tract from the airway to the upper-gastrointestinal tract bypasses the normal protection offered by the laryngeal reflexes. As a consequence, this situation can present the anaesthetist with significant difficulties. The proximity of the oesophagus, trachea, upper mediastinal contents and large blood vessels can further complicate surgery and anaesthesia.1


   Aetiology and pathophysiology
 
Over the last three decades the aetiology of acquired TOF has changed. Iatrogenic, malignant and traumatic causes have now superseded infection, formerly . . . [Full Text of this Article]

Malignancy

Tracheal tube related

Trauma

Granulomatous infection

Surgical complication


   Pathological sequelae
 

   Clinical presentation
 

   Investigations
 

   Preoperative management
 

   Operative management
 
Surgery

Anaesthesia


   Oesophageal stenting
 

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