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BJA Advance Access published online on October 29, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh298
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted August 23, 2004

Case Report

Burns and tracheo-oesophageal-cutaneous fistula

N. Eipe 1*, A. D. Pillai 2, and R. Choudhrie 2

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

* To whom correspondence should be addressed.
N. Eipe, E-mail: neipe{at}yahoo.com


  Abstract

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.

Keywords: airway, management; burns, electric; complications, tracheo-oesphageal-cutaneous fistula.
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