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Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges

Acquired, nonmalignant tracheoesophageal fistulas (TEFs) often occur in the setting of prolonged use of endotracheal or tracheostomy tubes due to trauma and erosion of the tracheal wall inflicted by tube cuffs or direct tracheal contact. In this report, we present a patient with a tracheostomy who p...

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Detalles Bibliográficos
Autores principales: Hasan, Leen, Sharma, Bashar, Goldenberg, Steven A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015068/
https://www.ncbi.nlm.nih.gov/pubmed/35464543
http://dx.doi.org/10.7759/cureus.23324
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author Hasan, Leen
Sharma, Bashar
Goldenberg, Steven A
author_facet Hasan, Leen
Sharma, Bashar
Goldenberg, Steven A
author_sort Hasan, Leen
collection PubMed
description Acquired, nonmalignant tracheoesophageal fistulas (TEFs) often occur in the setting of prolonged use of endotracheal or tracheostomy tubes due to trauma and erosion of the tracheal wall inflicted by tube cuffs or direct tracheal contact. In this report, we present a patient with a tracheostomy who presented with recurrent aspiration pneumonia and was found to have a large TEF that was difficult to treat. We also discuss the diagnostic and management challenges concerning TEFs. TEFs, especially if large, lead to recurrent aspiration pneumonia and can be challenging to manage. Definitive management of TEFs involves surgical repair; meanwhile, endoscopic or bronchoscopic stenting to bypass the fistula can be performed. The fistula location, size, and concurrent positive pressure ventilation make its treatment challenging in those with chronic ventilatory dependence. Early recognition and multidisciplinary management involving gastroenterologists, interventional pulmonologists, and thoracic surgeons are necessary to decide on the best treatment strategy.
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spelling pubmed-90150682022-04-22 Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges Hasan, Leen Sharma, Bashar Goldenberg, Steven A Cureus Internal Medicine Acquired, nonmalignant tracheoesophageal fistulas (TEFs) often occur in the setting of prolonged use of endotracheal or tracheostomy tubes due to trauma and erosion of the tracheal wall inflicted by tube cuffs or direct tracheal contact. In this report, we present a patient with a tracheostomy who presented with recurrent aspiration pneumonia and was found to have a large TEF that was difficult to treat. We also discuss the diagnostic and management challenges concerning TEFs. TEFs, especially if large, lead to recurrent aspiration pneumonia and can be challenging to manage. Definitive management of TEFs involves surgical repair; meanwhile, endoscopic or bronchoscopic stenting to bypass the fistula can be performed. The fistula location, size, and concurrent positive pressure ventilation make its treatment challenging in those with chronic ventilatory dependence. Early recognition and multidisciplinary management involving gastroenterologists, interventional pulmonologists, and thoracic surgeons are necessary to decide on the best treatment strategy. Cureus 2022-03-19 /pmc/articles/PMC9015068/ /pubmed/35464543 http://dx.doi.org/10.7759/cureus.23324 Text en Copyright © 2022, Hasan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Hasan, Leen
Sharma, Bashar
Goldenberg, Steven A
Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title_full Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title_fullStr Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title_full_unstemmed Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title_short Acquired Tracheoesophageal Fistulas: A Case Report and Review of Diagnostic and Management Challenges
title_sort acquired tracheoesophageal fistulas: a case report and review of diagnostic and management challenges
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015068/
https://www.ncbi.nlm.nih.gov/pubmed/35464543
http://dx.doi.org/10.7759/cureus.23324
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