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A Catheter-Guided Technique for Second Branchial Cleft Fistula Excision in Infants: A Case Report
Akio Kawami1, Yudai Goto1, Yuri Nemoto1
1Department of Pediatric Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Insights
A novel technique using a peripherally inserted central venous catheter (PICC) as a guide successfully treated a second branchial cleft (SBC) fistula in an infant. This method enhances surgical precision for complex pediatric cases, reducing recurrence risks.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Medical Devices
Background:
- Second branchial cleft (SBC) fistulas are common congenital anomalies.
- Surgical excision is standard but challenging in infants due to narrow tracts and poor visualization.
- These challenges increase risks of complications and recurrence.
Introduction:
Second branchial cleft (SBC) fistulas are the most common branchial cleft anomalies and typically present in infancy or early childhood. While complete surgical excision is the standard treatment, surgical challenges in younger children arise because of narrower fistula tracts and inadequate visualization, which increase the risk of complications and recurrence.
Case Presentation:
We report the case of a 6-month-old boy with an SBC fistula who presented with persistent mucoid discharge from a right cervical orifice. Fistulography confirmed the presence of a complete SBC fistula. At 9 months of age, a fistulectomy was performed using a 28-gauge peripherally inserted central venous catheter (PICC) as a guide to identify the entire fistula tract. The catheter facilitated the precise identification of the fistula tract, saline irrigation, dissection under endoscopic guidance, and confirmation of the internal end by creating a knot at the catheter tip. The tract was excised completely without any complications. The patient recovered uneventfully and showed no recurrence at 6 months postoperatively.
Conclusions:
Complete surgical resection remains the gold standard for SBC fistulas. However, anatomical challenges in younger children limit the applicability of various intraoperative tools and techniques. The use of a small-diameter catheter as a guide to identify an entire fistula tract is a valuable approach that overcomes these challenges, enhances surgical precision, and reduces the risk of complications and recurrence.
