Transtracheal approach to repair of a tracheo-colonic fistula 44 years after colonic interposition

Head Neck. 2014 Nov;36(11):E117-20. doi: 10.1002/hed.23586. Epub 2014 Apr 3.

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.

Conclusion: 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.

Keywords: aspiration; colonic interposition; tracheal fistula; tracheal reconstruction; tracheoesophageal fistula.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Bronchoscopy / methods*
  • Colon / surgery
  • Colon / transplantation*
  • Colonic Diseases / diagnosis*
  • Colonic Diseases / surgery
  • Follow-Up Studies
  • Humans
  • Intestinal Fistula / diagnosis*
  • Intestinal Fistula / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods
  • Rare Diseases
  • Reoperation / methods
  • Risk Assessment
  • Time Factors
  • Tracheal Diseases / diagnosis*
  • Tracheal Diseases / surgery
  • Tracheoesophageal Fistula / congenital*
  • Tracheoesophageal Fistula / surgery
  • Treatment Outcome