Case report: tracheoesophageal fistula secondary to post-intubation tracheomegaly in a tetanus patient.

ABSTRACT

Tracheomegaly and tracheoesophageal fistula (TEF) may be complicated within 12-200 days (with a mean of 43 days) of mechanical ventilation but rare in short-term intubation. Here we present a case of TEF secondary to post-intubation tracheomegaly in a tetanus patient. A 49-year-old male was admitted to the emergency room (ER) and diagnosed with tetanus. He became intubated and mechanically ventilated, but showed over-inflation of the endotracheal tube cuff on X-ray and chest computed tomography since the 8th day. After extubation, the patient had severe coughing during eating. Fiberoptic bronchoscopy and gastroscopy demonstrated a TEF located at the anterior wall of the esophagus. Esophageal exclusion and jejunostomy were performed to heal the fistula. The recurrent and uncontrollable muscular rigidity and spasms might be the main cause early tracheomegaly and TEF. Short-term intubation induced TEF should be aware of in specific patients. Both cuff pressure and cuff volume should be monitored to minimize tracheoesophageal injuries in such cases.