title: Transtracheal approach to repair of a tracheo-colonic fistula 44 years after colonic interposition.
abstract: BACKGROUND
  We present a case report of a trachea-colonic fistula and demonstrate our unique approach to repair, which was efficient and effective.
  
  
  METHODS
  The patient was a 50-year-old man who had a congenital tracheoesophageal fistula repair with colonic interposition as a child who now developed a fistula between his colon and trachea.
  
  
  RESULTS
  We performed a transtracheal approach, with primary closure of redundant colon mucosa as well as direct repair of the trachea. An inferiorly based sternocleidomastoid muscle flap was interposed between these 2 layers to augment the repair. The patient had an uneventful recovery with an effective reconstitution of the alimentary tract and the airway.
  
  
  CONCLUSIONS
  Tracheo-colonic fistula is an extremely rare pathology, and the scarring that develops after a prior esophagectomy makes a traditional lateral approach very difficult. The transtracheal approach is an effective method to obtain needed exposure in order to carry out the repair.
authors.affiliation: Department of Surgery (Otolaryngology), Yale University, School of Medicine, New Haven, Connecticut.
authors.forename: Saral
authors.initials: S
authors.lastname: Mehra
authors.forename: Sophie
authors.initials: S
authors.lastname: Scherl
authors.forename: Cathy
authors.initials: C
authors.lastname: Lazarus
authors.forename: Eliza
authors.initials: E
authors.lastname: Dewey
authors.forename: Mark L
authors.initials: ML
authors.lastname: Urken
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D003106:Colon / Q000601:surgery / Q000637:transplantation*; D003108:Colonic Diseases / Q000175:diagnosis* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D035583:Rare Diseases; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D014133:Tracheal Diseases / Q000175:diagnosis* / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000151:congenital* / Q000601:surgery; D016896:Treatment Outcome
keywords: aspiration; colonic interposition; tracheal fistula; tracheal reconstruction; tracheoesophageal fistula