Successful Airway Management in a Patient with Tracheal Stenosis and Tracheoesophageal Fistula: a Case Report

A twenty-year-oldgirl was referred with tracheal stenosis (TS) which was a consequence ofprolonged intubation after head injury because ofprevious car accident. The patient wasaphasic and had normal respiration. Fiberoptic bronchoscopy showed completetracheal obstruction at second tracheal ring level. Distal trachea was normalthrough tracheostomy tube. Removal ofthe tracheostomy tube and blind reinsertion with a new one was complicated withhypoxia and respiratory distress. Fibrotic bronchoscopy revealed largetracheoesophageal fistula (TEF) below tracheal obstruction. Reinsertion of the tracheostomy tube by fiberoptic bronchoscope was successful. Multidetector CT scan was performed on thesame day with confirmation of TS combined with TEF. Surgery was performed onthe next day. No clinical evidence of TEF was found in back history. Inadequateevaluation of the whole length of the trachea during the first bronchoscopy wasthe reasons for missing TEF. TEF should be considered in patients with TS inspite of no typical symptom such as food aspiration or pulmonary infections.