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British Journal of Anaesthesia, 1989, Vol. 63, No. 4 492-496
© 1989 The Board of Management and Trustees of the British Journal of Anaesthesia

case-report

ANAESTHETIC MANAGEMENT OF MALIGNANT TRACHEO—OESOPHAGEAL FISTULA

C. R. GREBENIK, M.B., CH.B., F.F.A.R.C.S.

Department of Anaesthesia and Intensive Care, The Austin Hospital Heidelberg, Victoria 3084, Australia

Present address: Department of Anaesthesia, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE.

The anaesthetic management is described, of a patient with malignant tracheo—oesophageal fistula undergoing palliative oesophageal bypass. The oesophagus was divided and closed at its upper end and replaced with a segment of colon. The fistula remained in situ and fundoplication was performed to allow drainage of the oesophageal remnant but prevent reflux of gastric contents. During a subsequent anaesthetic, gross intestinal distension occurred when gas that had passed through the fistula was unable to vent. The problems of dealing with patients with malignant tracheo—oesophageal fistula are discussed.


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