Tracheoesophageal Fistula Complicated by Iatrogenic Gastric Perforation in a Low Birth Weight Neonate

Type-III tracheoesophageal fistula is the commonest type of fistula where upper pouch is blind and distal oesophageal pouch communicates with trachea. In this condition, gastric distension is a common manifestation which can be worsened by positive pressure ventilation. Pulmonary pathology may necessitate ventilation with high peak airway pressures which may rarely lead to gastric perforation with serious consequences. We are reporting such a case of gastric perforation during ventilatory management for fistula repair which needed surgical repair. Keywords: Airway management; esophageal atresia; gastric perforation; tracheo-oesophageal fistula.

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Anesthesia Practice: Review of Perioperative Management of H-Type Tracheoesophageal Fistula

Anesthesiology Research and Practice ◽

10.1155/2019/8621801 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Bret Edelman ◽

Bright Jebaraj Selvaraj ◽

Minal Joshi ◽

Uday Patil ◽

Joel Yarmush

Keyword(s):

Tracheoesophageal Fistula ◽

Positive Pressure Ventilation ◽

Perioperative Management ◽

Anesthetic Management ◽

Gastric Distension ◽

Positive Pressure ◽

Right Thoracotomy ◽

Cervical Approach ◽

Practice Review ◽

Barium Esophagogram

Tracheoesophageal fistula (TEF) is a rare congenital developmental anomaly, affecting 1 in 2500–3000 live births. The H-type TEF, consisting of a fistula between the trachea and a patent esophagus, is one of the rare anatomic subtypes, accounting for 4% of all TEFs. The presentation and perioperative management of neonates with H-type TEFs and all other TEFs are very similar to each other. Patients present with congenital heart disease and other defects and are prone to recurrent aspirations. A barium esophagogram or computed tomography of the chest is a common means to the diagnosis, and surgical repair is carried out through either a cervical approach or a right thoracotomy. During operation, anesthetic management is focused on preventing positive pressure ventilation through the fistula in an attempt to minimize gastric distension. For patients with H-type TEFs, because of the patent esophagus, symptoms are often less severe and nonspecific, resulting in subtle yet important differences in their diagnostic workup and management. This review will cover the finer details in the diagnosis and perioperative anesthetic management of TEF patients and clarify how H-type TEF distinguishes itself from the other anatomic subtypes.

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Pneumoesophagus as a Sign of H Type Tracheoesophageal Fistula

PEDIATRICS ◽

10.1542/peds.58.6.907 ◽

1976 ◽

Vol 58 (6) ◽

pp. 907-909

Author(s):

Wilbur L. Smith ◽

E. A. Franken ◽

John A. Smith

Keyword(s):

Endotracheal Intubation ◽

Tracheoesophageal Fistula ◽

Positive Pressure Ventilation ◽

Positive Pressure

Two patients with H type tracheoesophageal fistulae demonstrated prominent pneumoesophagus and gaseous distention of the bowel after endotracheal intubation and positive-pressure ventilation. This report discusses the pathophysiology of these events and emphasizes the significance of these findings.

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Hemopneumothorax in a COPD Patient Treated with Noninvasive Positive Pressure Ventilation: The Risk of Attendant Anticoagulation

Canadian Respiratory Journal ◽

10.1155/2004/971743 ◽

2004 ◽

Vol 11 (2) ◽

pp. 159-162 ◽

Cited By ~ 3

Author(s):

R Raghavan ◽

AK Ellis ◽

W Wobeser ◽

KB Sutherland ◽

DE O'Donnell

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Positive Pressure Ventilation ◽

Work Of Breathing ◽

Noninvasive Positive Pressure Ventilation ◽

Air Embolism ◽

Gastric Distension ◽

Positive Pressure ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Severe Copd

Noninvasive positive pressure ventilation (NIPPV) modalities have been proven to be effective in the setting of exacerbations of chronic obstructive pulmonary disease (COPD). Reported complications include pneumothorax, increased work of breathing, gastric distension and air embolism. This case demonstrates that patients with severe COPD on anticoagulant therapy are potentially at risk for the serious complication of combined lung barotrauma and hemorrhage while on acute NIPPV therapy. This is the first reported case of hemopneumothorax complicating NIPPV therapy.

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Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux

10.32920/14669004.v1 ◽

2021 ◽

Author(s):

Jennifer Beck ◽

Danny Cantin ◽

Djamal Djeddi ◽

Vincent Carrière ◽

Nathalie Samson ◽

...

Keyword(s):

Positive Pressure Ventilation ◽

Inhibitory Effect ◽

Intermittent Positive Pressure Ventilation ◽

Gastric Distension ◽

Positive Pressure ◽

Neurally Adjusted Ventilatory Assist ◽

Laryngeal Closure ◽

Strong Inhibitory Effect ◽

Nasal Pressure ◽

Transient Relaxation

Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV), contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA), triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i) gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii) esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH2O) and nNAVA (~ 15/4 cmH2O). The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range), decreased during both nPSV (1 (0, 3)) and nNAVA [1 (0, 3)] compared to control condition (5 (3, 10)), (p < 0.05). Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61) h-1) and nNAVA (10 (9, 56) h-1) (p = 0.8). In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure.

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Tracheoesophageal Fistula Repair

10.1093/med/9780199764495.003.0053 ◽

2013 ◽

Author(s):

Lorna Rankin

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Congenital Malformation ◽

Tracheoesophageal Fistula ◽

Positive Pressure Ventilation ◽

Perioperative Period ◽

Positive Pressure ◽

Fistula Repair ◽

Risk Of Aspiration ◽

Associated Abnormalities

Tracheoesophageal fistula (TEF) and esophageal atresia (EA) is a congenital malformation occurring in 1:3,000 to 4,500 births. The condition presents specific challenges to the anesthesiologist in the perioperative period. The presence of a fistula means that infants born with TEF/EA are at risk of aspiration and positive-pressure ventilation may be hazardous. These babies often have coexistent problems associated with prematurity and low birth weight, and 50% have associated abnormalities, most commonly congenital cardiac malformations.

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Laparoscopic Repair of Duodenal Atresia in a Low Birth Weight Neonate

The American Surgeon ◽

10.1177/000313481408000910 ◽

2014 ◽

Vol 80 (9) ◽

pp. 834-835 ◽

Cited By ~ 4

Author(s):

Armando Rosales-Velderrain ◽

Abraham Betancourt ◽

Fuad Alkhoury

Keyword(s):

Birth Weight ◽

Gas Exchange ◽

Laparoscopic Repair ◽

Small Volume ◽

Positive Pressure Ventilation ◽

Duodenal Atresia ◽

Positive Pressure ◽

Knot Tying ◽

Intracorporeal Suturing ◽

Birth Weight Neonate

The small volume of the infant abdomen limits the application of laparoscopic procedures. We successfully repaired a duodenal atresia in a 2-kg female infant using a standard diamond-shaped anastomosis and intracorporeal suturing and knot-tying techniques. Anesthesia and positive pressure ventilation assured adequate gas exchange during pneumoperitoneum during the procedure.

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Endotracheal tube blockage during tracheo-oesophageal fistula surgery: A case report

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v9i4.38095 ◽

2020 ◽

Vol 9 (4) ◽

pp. 224-227

Author(s):

Anjali Poudel ◽

Balkrishna Bhattarai ◽

Nirman Prasad Gyawali ◽

Rajesh Prasad Sah ◽

Ashik Rajak

Keyword(s):

Case Report ◽

Endotracheal Tube ◽

Positive Pressure Ventilation ◽

Anaesthetic Management ◽

Difficult Tracheal Intubation ◽

Near Miss ◽

Gastric Distension ◽

Positive Pressure ◽

Anesthetic Depth ◽

Fistula Surgery

The multifarious anaesthetic challenges associated with tracheo-oesophageal fistula surgery are difficult tracheal intubation, continuous air leakage during positive pressure ventilation, gastric distension, sharing of the airway with surgeons, intraoperative desaturation due to surgical retractors and maintaining anesthetic depth. These challenges are managed properly only when pathophysiology of the fistula is well understood. In this case report we present an anaesthetic management with a near miss situation during repair of tracheo-oesophageal fistula in a neonate. Intraoperatively, the patient’s oxygen saturation decreased which did not improve despite correcting all possible reasons. Before the worst could have occurred, we identified endotracheal tube blockage as the cause and changing the tube on time saved the neonate.

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