Anaesthetic management of malignant tracheo-oesophageal fistula

The anaesthetic management is described, of a patient with malignant tracheo-oesophageal fistula undergoing palliative oesophageal bypass. The oesophagus was divided and closed at its upper end and replaced with a segment of colon. The fistula remained in situ and fundoplication was performed to allow drainage of the oesophageal remnant but prevent reflux of gastric contents. During a subsequent anaesthetic, gross intestinal distension occurred when gas that had passed through the fistula was unable to vent. The problems of dealing with patients with malignant tracheo-oesophageal fistula are discussed.