[Treatment of esophagotracheal fistula following intensive care. An experience of 17 cases].
Oesophago-tracheal fistulae secondary to respiratory intensive care have become the commonest type of non-tumoural fistula in adults: 17/26 cases. They complicated a long period of difficult and septic intensive care, after a mean interval of 30 days. The diagnosis was confirmed by bronchoscopy which also provided good assessment of the site and extent of the fistula and the associated tracheal lesions. The severity of this complication is stressed by 5 deaths in the present series (1 toxi-infectious syndrome after 24 hours, 2 abandonments due to a hopeless resuscitation prognosis, 2 cases of oesophago-tracheal reflux which could have been prevented). One should not wait for spontaneous cure (although this did take place in 2 cases). Ideal direct suture (9 cases: 9 cures) requires local conditions favourable for healing and rapid respiratory autonomy. These conditions can be achieved by an active approach to protection against oesophago-tracheal reflux: at least lower oesophageal exclusion (4 cases) by ligation or anti-reflux operation. Oesophageal exclusion followed by oesophago-coloplasty is sometimes the only solution in cases of severe destruction of cervico-mediastinal tissues (2 cases: 1 cure). Five tracheal strictures required an associated resection-anastomosis (5 cures).
Couraud
L
L
Bercovici
D
D
Zanotti
L
L
Clerc
P
P
Velly
J F
JF
Dubrez
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001999:Bronchoscopy; D003422:Critical Care; D004944:Esophagoplasty; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013536:Suture Techniques; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000628:therapy*
Traitement des fistules oesophago-trachéales de la réanimation (FOT). Expérience de dix-sept cas.