Individualized Stent for Tracheal Fistula Complicating Tracheostomy Following Esophagectomy

Delayed-onset tracheal fistula following esophagectomy with concurrent tracheostomy is rare and poses diagnostic challenges. A 79-year-old female patient with oesophageal squamous cell carcinoma (ESCC) developed a tracheal fistula following esophagectomy and tracheostomy. Repeated bronchoscopies via the tracheostoma failed to visualize the fistula orifice; the diagnosis was confirmed by computed tomography (CT) with oral contrast medium and complete tracheal inspection following temporary removal of the tracheostomy tube. A patient-specific, fully covered self-expandable metallic stent (FCSEMS) was implanted under endoscopic guidance. At 53 days of follow-up, the stent remained well-positioned without aspiration recurrence. The patient ultimately succumbed to distant tumour metastasis and multidrug-resistant bacterial infection. Complete tracheobronchoscopy following temporary decannulation and CT with oral contrast medium facilitates the diagnosis of tracheal fistula. Individualized covered stenting achieves satisfactory fistula occlusion, thereby providing valuable clinical insights for the management of similar complex cases.