Multidisciplinary team approach on tracheoesophageal fistula in a patient with home ventilator

Journal of Thoracic Disease

article

Hyeran Kang¹  Kyung Sik Yi²  Sun-Hyung Kim¹  Bumhee Yang¹  Jun Yeun Cho¹  Kang Hyeon Choe¹  Ki Man Lee¹  Yoon Mi Shin¹  Hon Chi Suen³  Jacopo Vannucci⁴  Alfonso Fiorelli⁵ 

[1] Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine;Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine;The Hong Kong Cardiothoracic Surgery Center, Sanitorium and Hospital;Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I;Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”

关键词: Tracheoesophageal fistula (TEF);    adult;    ventilator;    pneumonia;    malnutrition;    death;   

DOI  :  10.21037/jtd-22-675

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

A 68-year-old man was transferred to our tertiary hospital. Ten years ago, he received radiation therapy for tonsil cancer, and while there was no evidence of recurrence, he suffered from recurrent aspiration. We treated his aspiration pneumonia in the intensive care unit. Prior to his discharge, he received percutaneous dilatational tracheostomy (PDT) before he was transferred to a nursing hospital. Nine months later, he was readmitted owing to tracheoesophageal fistula (TEF). However, he was considered unsuitable for conservative intervention after a multidisciplinary team discussion. Esophageal stent insertion was impossible due to the high level of TEF in the esophagus. Additionally, the size of the TEF could not be covered by an endosponge and endoluminal vacuum therapy, and there was no tracheal stent that could cover his large trachea. The preceding percutaneous enteral gastrostomy (PEG) procedure was required for the primary closure operation of the esophagus; however, family’s consent could not be obtained. After 1month, the patient and his family changed their minds and agreed to the procedure and we attempted to perform PEG procedure. However, we could not proceed with PEG owing to stenosis in the inlet of the esophagus. Then, the patient deteriorated clinically and died due to pneumonia with septic shock.

【 授权许可】

Unknown