Esophagotracheal perforation during an emergency intubation

The authors report the first known case of a simultaneous esophagotracheal perforation, which occurred during an emergency intubation of a patient with airway abnormalities. The perforation was suspected from the postintubation chest roentgenograph and confirmed by fiber optic bronchoscopy which showed that the endotracheal tube had entered through the posterior wall of the trachea after perforating the esophagus. The patient had a tracheostomy done and was placed on prophylactic antibiotic therapy; the esophageal tear was left to heal spontaneously. Risk factors for esophagotracheal perforation, means to avoid it, and diagnosis and treatment considerations are discussed.