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Paper Information

Journal:   ACTA MEDICA IRANICA   2014 , Volume 52 , Number 7; Page(s) 565 To 568.
 
Paper: 

SUCCESSFUL AIRWAY MANAGEMENT IN A PATIENT WITH TRACHEAL STENOSIS AND TRACHEOESOPHAGEAL FISTULA: A CASE REPORT

 
 
Author(s):  DAVARI HAMID REZA, LATIFI SAHAR*
 
* THORACIC WARD, VALIASR HOSPITAL, IMAM KHOMEINI HOSPITAL COMPLEX, KESHAVARZ BLV., TEHRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN
 
Abstract: 

A twenty-year-old girl was referred with tracheal stenosis (TS) which was a consequence of prolonged intubation after head injury because of previous car accident. The patient was aphasic and had normal respiration. Fiberoptic bronchoscopy showed complete tracheal obstruction at second tracheal ring level. Distal trachea was normal through tracheostomy tube. Removal of the tracheostomy tube and blind reinsertion with a new one was complicated with hypoxia and respiratory distress. Fibrotic bronchoscopy revealed large tracheoesophageal fistula (TEF) below tracheal obstruction. Reinsertion of the tracheostomy tube by fiber optic bronchoscope was successful. Multidetector CT scan was performed on the same day with confirmation of TS combined with TEF. Surgery was performed on the next day. No clinical evidence of TEF was found in back history. Inadequate evaluation of the whole length of the trachea during the first bronchoscopy was the reasons for missing TEF. TEF should be considered in patients with TS in spite of no typical symptom such as food aspiration or pulmonary infections.

 
Keyword(s): TRACHEOESOPHAGEAL FISTULA, TRACHEAL STENOSIS, TRACHEOSTOMY, AIRWAY MANAGEMENT
 
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