Lagrotta Gustavo, Ayad Mina, Butt Ifrah, Danckers Mauricio
Graduate Medical Education, Pulmonary Disease, Aventura Hospital and Medical Center, Aventura, FL 33180, United States.
Department of Internal Medicine, Aventura Hospital and Medical Center, Aventura, FL 33180, United States.
World J Crit Care Med. 2022 Sep 9;11(5):335-341. doi: 10.5492/wjccm.v11.i5.335.
Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.
We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt. He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit. The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest. Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.
The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression. We aim to illustrate pitfalls in the endoscopic examination and provide further awareness on critical care monitoring and management strategies to reduce its morbidity and mortality.
气管食管瘘和支气管食管瘘及其在成人中的潜在并发症在临床实践中很少见，但具有较高的发病率和死亡率。
我们报告一例39岁身体健康的男性，他在自杀未遂时摄入了下水道清洁剂，随后被送往我院。他在重症监护病房住院期间意外发生心脏骤停。患者出现了广泛的节段性气管-支气管-食管瘘道，导致胃和十二指肠内容物突然大量误吸，随后发生心肺骤停。尽管最初对其腐蚀性损伤采用食管支架置入术进行治疗，但瘘道延伸的内镜评估显示疾病进展缓慢且延迟。
本病例报告的目的是与读者分享气管-支气管-食管瘘的严重自然病程及其延迟进展情况。我们旨在说明内镜检查中的陷阱，并提高对重症监护监测和管理策略的认识，以降低其发病率和死亡率。
