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Telo M, Morais L, Ferreira R, Coelho AP, Peixer I. Unexpected Presentation of Tracheoesophageal Fistula During Intubation in a Pediatric Patient. Cureus 2023; 15:e50761. [PMID: 38125693 PMCID: PMC10731626 DOI: 10.7759/cureus.50761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and esophagus. This report presents a rare case of a pediatric patient who developed a TEF due to battery ingestion, which was diagnosed during intubation and resulted in cardiac arrest. A 4-year-old child with a two-year history of battery ingestion presented with severe dehydration, weight loss, and recurrent respiratory tract infections. Chest X-ray revealed a radiopaque foreign body in the esophagus. During general anesthesia for central venous line insertion and after endotracheal intubation, some difficulties in ventilation occurred, characterized by the inability to reach tidal volume, absence of capnography, and stomach distention which led to hypoxia and ultimately to cardiac arrest. Prompt resuscitation (CPR) was initiated, and selective right bronchial intubation during CPR improved the patient's condition. Subsequent bronchofibroscopy performed in the ICU confirmed the TEF, which was surgically corrected during the hospital stay. TEF poses challenges in anesthesia and airway management, particularly when positive pressure ventilation is used. In this case, the TEF was diagnosed during intubation, highlighting the critical role of clinical expertise and prompt intervention in managing this unexpected pediatric critical event.
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Affiliation(s)
| | - Larissa Morais
- Anesthesiology, Hospital Professor Doutor Fernando Fonseca, Lisbon, PRT
| | | | - Adelaide P Coelho
- Anesthesiology, Centro Hospitalar Universitário de Lisboa Central - Hospital Dona Estefânia, Lisbon, PRT
| | - Ivanete Peixer
- Anesthesiology, Centro Hospitalar Universitário de Lisboa Central - Hospital Dona Estefânia, Lisbon, PRT
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Poupore NS, Shih MC, Nguyen SA, Brennan EA, Clemmens CS, Pecha PP, McDuffie LA, Carroll WW. Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review. Int J Pediatr Otorhinolaryngol 2022; 157:111100. [PMID: 35523610 DOI: 10.1016/j.ijporl.2022.111100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature. METHODS In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups. RESULTS A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups. CONCLUSION A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.
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Affiliation(s)
- Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Michael C Shih
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Emily A Brennan
- Medical University of South Carolina, Department of Research and Education Services, Medical University of South Carolina Libraries, 171 Ashley Avenue, Charleston, SC, 29425, USA
| | - Clarice S Clemmens
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Lucas A McDuffie
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
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Singley PM, Peterson TJ, Rallya WE, Iaconetti DJ, Khandhar SJ, Hodgson JA. Maintaining One-Lung Ventilation With an Endobronchial Blocker Through a Damaged Left-Sided Double-Lumen Tube: A Case Report. A A Pract 2022; 16:e01586. [PMID: 35605173 DOI: 10.1213/xaa.0000000000001586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One-lung ventilation (OLV) can be accomplished utilizing a double-lumen tube (DLT) and an endobronchial blocker (EBB) or intentionally placing a standard endotracheal tube (ETT) into a mainstem bronchus. However, secondary options must be available should the primary method fail. We present a case where an EBB and a fiberoptic bronchoscope (FOB) were successfully passed through a left-sided DLT to reestablish right-lung isolation after the DLT bronchial cuff was surgically damaged. We advocate competency in placing both DLTs and EBBs, as well as having EBBs readily accessible as a secondary isolation method during OLV.
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Affiliation(s)
- Patrick M Singley
- From the Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thomas J Peterson
- From the Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - William E Rallya
- From the Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - John A Hodgson
- From the Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Departments of Anesthesiology
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Wang ZM, Zhang SC, Teng X. Esophageal diverticulum serves as a unique cause of bronchoesophageal fistula in children: A case report. Medicine (Baltimore) 2017; 96:e9492. [PMID: 29390593 PMCID: PMC5758295 DOI: 10.1097/md.0000000000009492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
RATIONALE Most of the esophageal diverticulums are congenital traction instead of in childhood. In most conditions, esophageal diverticulums are free of any symptoms. As one of the rare entity, esophageal diverticulum can also result in bronchoesophageal fistula. PATIENT CONCERNS A 10-year-old girl was admitted due to a 2-month history of cough and choking after drinking, and fever for 3 days. No symptoms when taking solid food were found. DIAGNOSES By esophagogram, 3-dimensional computed tomography and esophagoscopy, an esophageal diverticulum was demonstrated in the middle esophagus with a bronchoesophageal fistula visualized. Then the diagnoses of esophageal diverticulum and bronchoesophageal fistula were established. INTERVENTIONS A regular trans-anterolateral thoracotomy was carried out under general anesthesia with patient lying on the right side. The diverticulum was then removed and the fistulous tract was closed. OUTCOMES The girl discharged on the 14th postoperative day and received a regular monthly follow-up, at present, no recurrence was found. LESSONS Bronchoesophageal fistula may be a complication of esophageal diverticula, and should be considered in cases of unexplained cough or recurrent pneumonia.
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Affiliation(s)
- Zhi-Ming Wang
- Department of Oral and Maxillofacial Surgery Department of Pediatric Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Rajagopalan R, Selvam V, Baidya DK, Roychoudhury A. Novel use of Foley catheter to reduce leak around endotracheal tube in a child with temporo-mandibular joint ankylosis. Paediatr Anaesth 2014; 24:1306-7. [PMID: 25378041 DOI: 10.1111/pan.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rajaganesh Rajagopalan
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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