We have located links that may give you full text access.
Gaseous Bowel Distention: An Atypical Sign of Acquired Tracheoesophageal Fistula (TEF).
Chest 2014 October 2
SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Tracheoesophageal Fistula (TEF) is a rare (≤ 1%) but serious complication of tracheostomy caused by mucosal ischemia/abrasion secondary to prolonged intubation and use of high tracheal cuff pressures (≥ 30 cm H2O). We describe a challenging case of a patient on chronic ventilator support who presents with, multiple admissions for ventilator associated pneumonia (VAP), associated with gaseous bowel distention, was eventually found to have TEF on flexible bronchoscopy.
CASE PRESENTATION: A 31 y/o man on chronic ventilator support was brought to the ICU for worsening hypoxemia and hypotension. He had h/o quadriplegia secondary to a gunshot wound, chronic ventilator dependent respiratory failure with established tracheostomy and PEG for past 5 years. Patient was diagnosed with severe sepsis secondary to VAP after chest X-ray and CT scan showed increased bibasilar infiltrates. This presentation was similar to one of his multiple previous admissions. Patient was found to have worsening abdominal distention, with bubbling from the PEG site. CT scan of the abdomen and pelvis without contrast showed distention of multiple loops of small bowel and proximal colon, suggestive of an ileus pattern, with no evidence of obstruction (see images). Abdominal X-rays from the prior 8 months showed continued distention of the intestinal loops without focal mechanical obstruction. His tracheal cuff pressures from last 6 months ranged from 24-30 cm H2O. Subsequently, a diagnosis of TEF was considered, but CT scan of the neck failed to show TEF. Flexible bronchoscopy, showed two small indentations on the posterior tracheal wall at the site of the tracheostomy cuff with intermittent drainage (see images). Patient was diagnosed with TEF. Considering patient being a poor surgical candidate, a longer tracheostomy tube was inserted to bypass the fistulae and tracheal cuff pressure to be maintained at < 25 cm H2O.DISCUSSION: This case illustrates challenges related to the diagnosis of TEF. Abdominal gaseous distension is a known clinical manifestation of TEF with esophageal atresia in the neonatal period, due to airflow through the fistula into the esophagus. However, while reported in neonates, it has not been reported as a clue in diagnosing TEF in older populations.CONCLUSIONS: With increasing use of tracheostomy in recent times, awareness of potential complications and their management is needed. TEF is primarily managed surgically or by stent placement, however, placement of a longer tracheostomy tube to bypass TEF with use of total parenteral nutrition (TPN) may be an option in certain patient populations. Reference #1: Intermmittent Gaseous Bowel Distention: Atypical Sign of Congenital Tracheoesophageal Fistula. Pediatric Pulmonology 44:244-248Reference #2: Acquired Tracheo-oesophageal fistula in adults. Continuing Education in Anaesthesia : Critical Care and pain. Volume 6 November 3 2006DISCLOSURE: The following authors have nothing to disclose: Karan Mahajan, Sameer Patel, Sanjay ShahNo Product/Research Disclosure Information.
CASE PRESENTATION: A 31 y/o man on chronic ventilator support was brought to the ICU for worsening hypoxemia and hypotension. He had h/o quadriplegia secondary to a gunshot wound, chronic ventilator dependent respiratory failure with established tracheostomy and PEG for past 5 years. Patient was diagnosed with severe sepsis secondary to VAP after chest X-ray and CT scan showed increased bibasilar infiltrates. This presentation was similar to one of his multiple previous admissions. Patient was found to have worsening abdominal distention, with bubbling from the PEG site. CT scan of the abdomen and pelvis without contrast showed distention of multiple loops of small bowel and proximal colon, suggestive of an ileus pattern, with no evidence of obstruction (see images). Abdominal X-rays from the prior 8 months showed continued distention of the intestinal loops without focal mechanical obstruction. His tracheal cuff pressures from last 6 months ranged from 24-30 cm H2O. Subsequently, a diagnosis of TEF was considered, but CT scan of the neck failed to show TEF. Flexible bronchoscopy, showed two small indentations on the posterior tracheal wall at the site of the tracheostomy cuff with intermittent drainage (see images). Patient was diagnosed with TEF. Considering patient being a poor surgical candidate, a longer tracheostomy tube was inserted to bypass the fistulae and tracheal cuff pressure to be maintained at < 25 cm H2O.DISCUSSION: This case illustrates challenges related to the diagnosis of TEF. Abdominal gaseous distension is a known clinical manifestation of TEF with esophageal atresia in the neonatal period, due to airflow through the fistula into the esophagus. However, while reported in neonates, it has not been reported as a clue in diagnosing TEF in older populations.CONCLUSIONS: With increasing use of tracheostomy in recent times, awareness of potential complications and their management is needed. TEF is primarily managed surgically or by stent placement, however, placement of a longer tracheostomy tube to bypass TEF with use of total parenteral nutrition (TPN) may be an option in certain patient populations. Reference #1: Intermmittent Gaseous Bowel Distention: Atypical Sign of Congenital Tracheoesophageal Fistula. Pediatric Pulmonology 44:244-248Reference #2: Acquired Tracheo-oesophageal fistula in adults. Continuing Education in Anaesthesia : Critical Care and pain. Volume 6 November 3 2006DISCLOSURE: The following authors have nothing to disclose: Karan Mahajan, Sameer Patel, Sanjay ShahNo Product/Research Disclosure Information.
Full text links
Related Resources
Trending Papers
Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management.International Journal of Molecular Sciences 2024 April 13
Executive Summary: State-of-the-Art Review: Unintended Consequences: Risk of Opportunistic Infections Associated with Long-term Glucocorticoid Therapies in Adults.Clinical Infectious Diseases 2024 April 11
Clinical practice guidelines on the management of status epilepticus in adults: A systematic review.Epilepsia 2024 April 13
Finerenone: From the Mechanism of Action to Clinical Use in Kidney Disease.Pharmaceuticals 2024 March 27
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app