1/57. Tracheocarotid artery fistula infected with methicillin-resistant staphylococcus aureus.Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion. Suitable procedures for its identification and for obtaining appropriate histopathological blocks are suggested. Presence of methicillin-resistant staphylococcus aureus (MRSA) has not been documented before and might have contributed to the genesis of the fistula in this case.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
2/57. Spontaneous closure of a large tracheal fistula due to descending necrotizing mediastinitis.We present a case of a 77-year-old man who had a large tracheal fistula due to descending necrotizing mediastinitis. He underwent long-term care with a respirator after mediastinal drainage operations. The fistula was covered spontaneously with the anterior wall of the esophagus 1.5 months postoperatively.- - - - - - - - - - ranking = 5keywords = trachea (Clic here for more details about this article) |
3/57. Non-malignant tracheo-gastric fistula following esophagectomy for cancer.Two cases of neoesophago-tracheal fistula are described. After esophagectomy for cancer a fistula developed between the trachea and the pulled-up stomach probably because of the ischaemic effect of the tracheostomy tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In one case, tracheal resection and anastomosis was necessary. The defect on the membranous trachea in both cases was patched with an autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the suture lines to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.- - - - - - - - - - ranking = 4keywords = trachea (Clic here for more details about this article) |
4/57. Trachea--innominate artery fistula following tracheostomy. Successful repair using an innominate vein graft.This report discusses the first recorded patient in whom a trachea--innominate artery fistula after tracheostomy was treated successfully by resection of the eroded segment of artery followed by graft replacement using the patient's left innominate vein. The mechanism of vessel erosion and its prevention are discussed. Also, suitable methods are presented for obtaining temporary control of the severe hemorrhage associated with a tracheoarterial fistula while simultaneously maintaining an adequate airway.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
5/57. Tracheo-innominate fistula after initial percutaneous tracheostomy.We report a tracheo-innominate fistula formation after tracheostomy in a 68-year-old man with guillain-barre syndrome. The initial percutaneous tracheostomy had to be revised surgically after the tube dislodged from its insertion site in the trachea. Three days later, massive bleeding occurred and emergency surgery revealed a fistula. This was surgically repaired but subsequently re-bled with a fatal outcome. The post mortem report found an aneurysmal ectatic innominate artery with a fistula involving the anterior tracheal wall. The aetiology, diagnosis and management of tracheo-innominate fistula are discussed.- - - - - - - - - - ranking = 2keywords = trachea (Clic here for more details about this article) |
6/57. Tracheal-innominate artery fistula caused by the endotracheal tube tip: case report and investigation of a fatal complication of prolonged intubation.CASE REPORT: A patient with extensive burns was intubated with an 8.0 mm internal diameter endotracheal tube (ETT) equipped with a subglottic suction port (Mallinckrodt HiLo Evac). The ETT was secured to a left upper molar with wire sutures throughout the hospitalization course to ensure airway stability. On the 40th day of intubation, the patient exsanguinated and died from a tracheo-innominate artery fistula. Postmortem examination revealed a 1 cm lesion of the left anterior tracheal wall at the position of the ETT tip. The prolonged stationary position of the ETT was considered the primary factor responsible for the fistula. Yet tracheo-innominate artery fistula normally is associated with high cuff pressures rather than with the tube tip. The special ETT construction required for the subglottic suction feature was suspected to have increased tube rigidity and may have played a contributory role. methods: The rigidity of the Mallinckrodt HiLo Evac was measured with a mechanical model and compared to 5 other commercially-available ETTs. Rigidity was expressed as the force generated by the ETT tip when the tube curvature was altered by 5 cm and 10 cm of flexion from its resting position. RESULTS: The mean force exerted by the Mallinckrodt HiLo Evac was 10.1 /- 2.8 g at 5 cm of flexion and 17.7 /- 5.1 g at 10 cm of flexion. This was significantly greater than all other ETT brands tested (by one-way analysis of variance and Student-Newman-Kuels test, p < 0.05). CONCLUSION: This case of fatal tracheo-innominate artery fistula formation associated with an ETT tip was unusual because of the extended duration of endotracheal intubation and the complexity of the patient's airway management problems. Our data suggest that the higher rigidity of the HiLo Evac ETT may have contributed to fistula development at the tube tip. However, we do not believe that the higher rigidity of the HiLo Evac ETT necessarily poses any greater risk than other ETTs under normal circumstances, in which the tube tip is not fixed in a stationary position for an extended period.- - - - - - - - - - ranking = 7keywords = trachea (Clic here for more details about this article) |
7/57. The anesthetic management of a case of tracheogastric fistula.IMPLICATIONS: A 68-yr-old man developed a tracheogastric fistula after esophageal resection with gastric interposition. We report the anesthetic management of this patient undergoing tracheal repair and fistula closure.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
8/57. Tracheo-innominate artery fistula: a rare complication in a laryngectomized patient.A tracheo-innominate artery fistula is an uncommon but frequently fatal complication of tracheostomy. Rarely, it can also occur in laryngectomized patients. We report a post-laryngectomy, post-radiotherapy patient using a metal tracheostomy tube, who developed a tracheo-innominate artery fistula about two months after radiotherapy. To our knowledge this is only the second reported case in a laryngectomized patient. The computed tomography (CT) angiography findings helped confirm the diagnosis and the patient was successfully managed by surgical exploration and ligation of the innominate artery. coagulase negative Staphylococcus aureus was cultured from a tracheal swab. The clinical features, CT angiography findings, management protocols and possible aetiological factors are discussed.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
9/57. Intrathoracic myoplasty for prosthesis infection after superior vena cava replacement for lung cancer.Prosthesis infection after lung and superior vena cava system resection for non-small cell lung cancer is a life-threatening complication. We report a case in which an intrathoracic muscle flap transposition was used to cure tracheal fistula associated with prosthesis infection without the explant of the vascular graft.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
10/57. A case of relapsing polychondritis involving placement of an expandable metallic stent.Relapsing polychondritis is a relatively uncommon disease characterized by recurrence of progressive inflammation of cartilaginous structures. Laryngotracheal involvement occurs in 50-70% of cases, and occasionally results in acute airway obstruction. We reported a case of relapsing polychondritis with severe tracheal stenosis that was treated by the placement of two expandable metallic stents. A 58-year-old man was hospitalized with fever and breathing difficulties. A tracheostomy was performed and a silicone T-tube was placed. A diagnosis of relapsing polychondritis was made based on the biopsy from auricular and tracheal cartilages. Two expandable metallic stents were placed in the trachea to bilateral main bronchus. This dilated the airway lumen and resulted in the dyspnea disappearing completely. However, 18 months later a sudden massive hemorrhage occurred through the tracheostoma, and he died of respiratory failure. autopsy showed a tracheoinnominate artery fistula. We discuss the management of relapsing polychondritis with severe tracheal stenosis.- - - - - - - - - - ranking = 5keywords = trachea (Clic here for more details about this article) |
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