MANAGEMENT OF A POSTTRAUMATIC TRACHEOESOPHAGEAL FISTULA FOLLOWING FAILED PRIMARY REPAIR

Tracheo-esophageal (T-E) fistulas secondary to blunt chest trauma are extremely uncommon. Once the diagnosis is confirmed, surgical correcti on is indicated as spontaneous healing rarely occurs. Should a barium esophagram demonstrate a persistent T-E fistula postoperatively, we su ggest that in the absence of clinical or radiological evidence of medi astinal or pulmonary infection, a conservative treatment regimen may b e considered in an attempt to resolve the fistula without surgical int ervention. Conservative management should be abandoned and surgery ind icated if mediastinitis or recurrent aspiration pneumonias occur, or t he fistula fails to heal within a four to six week period.