In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.

The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient

Nicola Rotolo
Primo
Conceptualization
;
Maria Cattoni
Secondo
Data Curation
;
Silvia De Maio;Luca Filipponi;Pau Mateo-Ramos;AndreaImperatori
Data Curation
2023-01-01

Abstract

In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.
2023
2023
https://doi.org/10.4081/monaldi.2023.2490
tracheoesophageal fistula; COVID-19; trachealresectionand reconstruction; prolonged mechanical ventilation, esophageal repairIntroduction
Rotolo, Nicola; Cattoni, MARIA ANGELA; DE MAIO, Silvia; Filipponi, Luca; MATEO RAMOS, Pau; Andreaimperatori,
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2154271
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