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BJA Advance Access originally published online on October 29, 2004
British Journal of Anaesthesia 2005 94(1):132-134; doi:10.1093/bja/aeh298
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004

CASE REPORT

Burns and tracheo-oesophageal-cutaneous fistula

N. Eipe1,*, A. D. Pillai2 and R. Choudhrie2

1 Department of Anaesthesia and 2 Department of Surgery, Padhar Hospital, Betul, Madhya Pradesh-460005, India

* Corresponding author. E-mail: neipe{at}yahoo.com

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.


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