Trans-tracheostomy repair of tracheo-esophageal fistula under endoscopic view in a 75-year-old woman
Tracheo-esophageal fistula is a life-threatening condition for fatal pulmonary complications. Surgery is the treatment of choice. Unfortunately, the most of patients are unfit for surgery and in these cases there is no a standardized management. Herein, we reported a clinical case of a 75-year-old-woman with a tracheoesophageal fistula related to tracheostomy. The fistula was localized 3.5 cm below the vocal folds and extended 3 cm distally. The patient’s poor clinical condition contraindicated surgery while the characteristics of fistula prevented any successfully endoscopic repair with standard methods as application of fibrin glue, clipping, or stenting. Thus, we performed a minimally invasive procedure as trans-tracheotomy closure of the fistula under endoscopic view. Under general anesthesia, the patient was intubated with a rigid bronchoscopy. The cannula was removed and a standard needle-holder was inserted through the tracheotomy. The tear was closed from the distal to the proximal ends with interrupted stitch. Following, a Montgomery T tube was inserted to protect the suture and maintain the air-way patency. At the last follow-up (7 months after the procedure), the patient was alive and tolerated a full diet.