7. Tracheoesophageal fistula
Tracheoesophageal fistulas develop when the trachea opens into the esophagus after tracheal lacerations. These rare but serious complications can occur with chest trauma, tracheal intubation or percutaneous dilatation tracheostomy. It can be seen after rigid tracheal intubation, respiratory failure emergencies or esophagectomy. Tracheal lacerations can also be caused by a variety of factors, including inexperienced physicians, improper stylet use, cuff overinflation, or coughing with a closed expiratory valve. Tracheal lesions caused by the cuff can be of two types, longitudinal and circular, due to cuff overinflation or cuff decubitus in the tracheal wall.
Diagnosis of tracheal lesions can be confirmed by radiological findings or bronchoscopy. Treatment approaches range from conservative non-surgical treatment to surgical interventions and carry a high mortality rate. The choice of treatment varies depending on the location of the tracheal injury and the patient’s respiratory status. In cases of severe respiratory failure, mechanical ventilation may restrict recovery and alternative approaches such as bypass or multi-tube use may be necessary 13.