Burns and tracheo-oesophageal-cutaneous fistula.
We report an unusual case of electric burns suffered by a 15-yr-old boy. The patient's neck had come in contact with a high voltage broken electric wire and by reflex he had pulled it away with his right hand. He presented with a tracheo-cutaneous fistula with a right-sided pneumothorax. Emergency airway management included insertion of a tracheostomy tube through the traumatic opening in the neck and insertion of an intercostal tube drain. When the diagnostic endoscopy revealed an externally communicating tracheo-oesophageal fistula, protecting the lower airways from gastrointestinal contamination became a priority. The patient was anaesthetized through the traumatic tracheostomy and a formal low tracheostomy was done below the level of the fistula. The patient then underwent oesophageal reconstruction with a stomach free flap. Tracheo-oesophageal-cutaneous fistula is a rare presentation of electric burns. The anaesthetic management of the emergency difficult airway in any penetrating neck injury can be extremely difficult requiring a carefully planned multi-disciplinary approach.
Eipe
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N
Department of Anaesthesia, Padhar Hospital, Betul, Madhya Pradesh-460005, India. neipe@yahoo.com
Pillai
A D
AD
Choudhrie
R
R
D000293:Adolescent; D000769:Anesthesia, Inhalation / Q000379:methods*; D002058:Burns, Electric / Q000150:complications / Q000601:surgery*; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D004630:Emergencies; D006801:Humans; D008297:Male; D019838:Neck Injuries / Q000209:etiology / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery