گزارش يك مورد تنگي تراشه همراه با فيستول تراشه به مري بدنبال لوله گذاري در ناي

A CASE OF POST-INTUBATION TRACHEAL STENOSIS AND TRACHEOESOPHAGEAL FISTULA

BACKGROUND AND OBJECTIVE: The presence of tracheal or tracheostomy tubes for long term in trachea, especially with nasogastric tube synchoronously, could be complicated by tracheal stenosis, tracheoesophageal-fistula and tracheo-innominate fistula. This report presents a 22-year-old man with post intubation tracheal stenosis and tracheoesophageal fistula, following long term intubations and simultaneous repair of tracheoesophageal fistula with a good result. CASE: The patient after car accident in comatose state was intubated and connected to ventilator for 3 weeks. Ten days after intubation, tracheostomy was performed on him. During this time, his nutrition was done by nasogastric tube. With beginning oral route nutrition, there was cough with each swallowing. In bronchoscopy there was mucosal inflammation and tracheal rings destruction in 3 cm below the vocal cords, with 2.5-3 cm in length that was accompanied by tracheoesophageal-fistula in the tracheal membranous wall. Because of dyspnea and tracheal stenosis, it was decided to resect the destructed part of the trachea and end- to- end anastomosis with fistula repair. CONCLUSION: In the presence of tracheoesophageal-fistula, correct judgment, pre- and postoperative cares are the key factors in the outcome of patients. Proper calorie calculation for the patient (enteral route) and. simultaneous repair of tracheal stenosis are the secret of the success in the surgery of these patients.