Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 11198-11203
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.11198
Accidental esophageal intubation via a large type C congenital tracheoesophageal fistula: A case report
Seong Min Hwang, Myeong Jin Kim, Sora Kim, Saeyoung Kim
Seong Min Hwang, Myeong Jin Kim, Sora Kim, Saeyoung Kim, Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Author contributions: Hwang SM contributed to manuscript writing and editing; Kim MJ and Kim SR contributed to data collection; Kim SY contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Saeyoung Kim, MD, PhD, Professor, Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, South Korea. saeyoungkim7@gmail.com
Received: August 1, 2022
Peer-review started: August 1, 2022
First decision: August 22, 2022
Revised: August 30, 2022
Accepted: September 19, 2022
Article in press: September 19, 2022
Published online: October 26, 2022
Processing time: 80 Days and 20.1 Hours
Abstract
BACKGROUND

Tracheoesophageal fistula (TEF) is a congenital anomaly characterized by interruptions in esophageal continuity with or without fistulous communication to the trachea. Anesthetic management during TEF repair is challenging because of the difficulty of perioperative airway management. It is important to determine the appropriate position of the endotracheal tube (ETT) for proper ventilation and to prevent excessive gastric dilatation. Therefore, the tip of the ETT should be placed immediately below the fistula and above the carina.

CASE SUMMARY

A full-term, one-day-old, 2.4 kg, 50 cm male neonate was diagnosed with TEF type C. During induction, an ETT was inserted using video laryngoscope and advanced deeply to ensure that the tip passed over the fistula, according to known strategies. The passage of the ETT through the vocal cords was confirmed via video laryngoscope. However, after inflating the ETT cuff, breath sounds were not heard on bilateral lung auscultation. Instead, gastric sounds were heard. Considering that a large fistula (approximately 6.60 mm × 4.54 mm) located 10.2 mm above the carina was confirmed on preoperative tracheal computed tomography, the possibility of unintentional esophageal intubation was highly suspected. Therefore, we decided to uncuff and withdraw the ETT carefully for repositioning, while monitoring auscultation and end-tidal CO2 simultaneously. At a certain point (9.5 cm from the lip), clear breath sounds and proper end-tidal CO2 readings were suddenly achieved, and adequate ventilation was possible.

CONCLUSION

Preanesthetic anatomical evaluation with imaging studies in TEF is necessary to minimize complications related to airway management.

Keywords: Tracheoesophageal fistula; Imaging study; Anatomy; Intubation; Airway management; Auscultation; Case report

Core Tip: Anesthetic management in tracheoesophageal fistula (TEF) repair is challenging for anesthesiologists because of the difficulty in airway management. Unexpected events during airway management can occur, resulting in catastrophic outcomes, such as desaturation, hypoxic damage, and even death. In our case, esophageal intubation was unintentionally performed because of the large fistula. We predicted the possibility of this event based on the preceding tracheal computed tomography, which helped us to obtain a better clinical outcome. Evaluating the anatomy of each patient with TEF using imaging studies before induction is essential to minimize complications and facilitate prompt management as necessary.