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Acquired tracheo-esophageal fistula in the pediatric population
1Department of Otorhinolaryngology Head and Neck Surgery, The New Children's Hospital, Royal Alexandra Hospital for Children, Westmead, NSW, Australia.
Insights
Acquired tracheo-esophageal fistula (TEF) is rare in children, often caused by tracheotomy tubes or foreign bodies. Early diagnosis and surgical repair are crucial as most TEF do not heal spontaneously.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Critical Care Medicine
Background:
- Acquired tracheo-esophageal fistula (TEF) is an uncommon complication in pediatric patients.
- Tracheotomy tubes, particularly the cuffs, and foreign body impaction are identified causes.
- Patients with burns face an elevated risk of tracheotomy-related complications, including TEF.
Observation:
- Maintaining 'safe' intracuff pressures may be detrimental in pediatric patients with potential airway burns.
- A small air leak is recommended when using a tracheotomy tube cuff to prevent mucosal damage.
- Most acquired TEF in children require surgical intervention for closure.
Findings:
- This paper details two pediatric cases of acquired TEF.
- A comprehensive literature review on acquired TEF in the pediatric population is presented.
Implications:
- Highlights the importance of vigilant monitoring for TEF in at-risk pediatric patients.
- Emphasizes the need for careful management of tracheotomy tube cuff pressures in pediatric airway burn cases.
- Underscores the necessity of surgical intervention for non-spontaneous TEF closure in children.
Abstract:
Acquired tracheo-esophageal fistula (TEF) in the paediatric population is a rare entity, an acquired fistula can be due to tracheotomy tubes and tracheotomy cuffs. Patients with burns are at greater risk from these tracheotomy complications. Acquired TEF can also occur due to a foreign body impaction. Prevention and early diagnosis are important. In patients with possible airway burns, 'safe' intracuff pressures maybe too high. To avoid further damage of the mucosa, the patient should have a small air leak maintained if a cuff is used. Most acquired TEF do not close spontaneously and surgical closure is required. Our paper presents two cases of acquired TEF in the pediatric population and reviews the literature on this subject.