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.