Management of a post-traumatic tracheo-esophageal fistula following failed primary repair

Tracheo-esophageal (T-E) fistulas secondary to blunt chest trauma are extremely uncommon. Once the diagnosis is confirmed, surgical correction is indicated as spontaneous healing rarely occurs. Should a barium esophagram demonstrate a persistent T-E fistula postoperatively, we suggest that in the absence of clinical or radiological evidence of mediastinal or pulmonary infection, a conservative treatment regimen may be considered in an attempt to resolve the fistula without surgical intervention. Conservative management should be abandoned and surgery indicated if mediastinitis or recurrent aspiration pneumonias occur, or the fistula fails to heal within a four to six week period.