Which of the following statement(s) is/are true concerning tracheoesophageal fistulas?
A, The majority of acquired tracheoesophageal fistulas are due to malignant diseaseB. A water-soluble contrast esophogram should be obtained for diagnosis
C. Malignant tracheoesophageal fistulas represent one of the few indications for endoesophageal prosthesis
D. A benign tracheoesophageal fistula from an endotracheal intubation injury often requires a thoracotomy for repair
E. none is true
The answer
is. A, The majority of acquired tracheoesophageal fistulas are due to malignant
disease, C. Malignant
tracheoesophageal fistulas represent one of the few indications for endoesophageal
prosthesis
Ninety percent of acquired fistulas between the
esophagus and tracheobronchial tree in adults are the result of malignant
disease. Tracheoesophageal fistulas complicate the course of disease in about
5% of patients who have esophageal carcinoma. Nearly 80% of patients with
malignant tracheoesophageal fistulas die within three months of the onset of
symptoms and in 85% of these patients, the cause of death is aspiration
pneumonia, not distant metastatic disease. For the most part, malignant
tracheoesophageal fistula represents incurable disease for which resection
carries significant mortality and is seldom indicated. Palliative relief of
recurrent aspiration is the aim of therapy. Effective occlusion of the fistula
may be achieved by insertion of one of a variety of available endoesophageal
endoprostheses. These tubes are placed into the esophagus with the aid of an
esophagoscope and may occlude the esophageal side of the fistula sufficiently
to allow swallowing of liquids without aspiration into the tracheobronchial
tree. More recently, expandable metal stents have been used successfully in the
treatment of malignant tracheoesophageal fistulas.
Nonmalignant fistulas result from the erosion by
contiguous infected subcarinal mediastinal lymph nodes; trauma; late sequelae
of chronic mid-esophageal traction diverticulum; or erosion by an endotracheal
or tracheostomy tube cuff in a patient requiring prolonged ventilatory support.
Small fistulas, such as resulting from an endotracheal intubation injury, are
approached through a cervical collar or oblique incision anterior to the
sternocleidomastoid muscle. Although such cuff injuries usually produce
circumferential tracheal damage which necessitates a tracheal resection, this
can also be performed through a cervical collar incision.
