Surgical management of tracheoesophageal fistula in a patient with COVID-19
Armas-Zárate, Francisco Javier1; Hernández-Pérez, Arlette1; Iñiguez-García, Marco Antonio1
2021, Number 4
2021; 80 (4)
ABSTRACT
COVID-19 pneumonia is associated with severe respiratory failure that requires orotracheal intubation and assisted mechanical ventilation. Among the risks of prolonged mechanical ventilation, one of the most feared and challenging is the development of a tracheoesophageal fistula due to the respiratory and nutritional alterations that it entails. The diagnostic method of choice is bronchoscopy. Spontaneous closure of the tracheoesophageal fistula is rare and surgical management is generally required for its definitive correction. We present the case of a patient with COVID-19 pneumonia who developed a tracheoesophageal fistula and required surgical management as definitive treatment.
KEYWORDS
Tracheoesophageal fistula, COVID-19, surgery.
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Figura 1: Imagen a través de broncoscopia flexible que muestra el cartílago cricoides y la porción proximal del stent esofágico migrado hacia la tráquea proximal (flecha).
Figura 2: Imagen a través de broncoscopia flexible a nivel de la fístula traqueoesofágica, que muestra la comunicación entre la tráquea (doble asterisco) y el esófago (asterisco) de aproximadamente 3 cm.
Figura 3: Imagen transoperatoria posterior a la disección entre tráquea (flecha) y esófago. Se observa el defecto esofágico de 3 cm (asterisco). Se aprecia la ventilación cruzada en tráquea a través del sitio de estoma traqueal.
Figura 5: Imagen operatoria final de la colocación de traqueostomía a nivel del segundo anillo traqueal y el drenaje subcutáneo que se dejó en el sitio quirúrgico.
Figura 6: Esofagograma a los siete días postquirúrgicos con ausencia de fuga del medio de contraste y adecuada luz esofágica y paso del medio de contraste a estómago.