An unusual cause of tracheal stenosis

Purpose: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. Clinical Features: The history was suggestive of obstructive airways diseas e with secondary bronchiectasis. Physical findings were crepitations and rh onchi all over the chest. Blood gases were normal. Chest X-ray showed bronc hiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in se vere hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and I cm length in the middle third of trachea, bronchietasis, and an air filed pocket between the trachea and esophagus. PFT showed a sev ere obstruction. Antitubercular treatment which was started on the presumpt ive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopne a with severe hypecarbia and acidosis. The anesthetic management of the tra cheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large fore ign body was found lying obliquely in the trachea dividing it into an anter ior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. Conclusion: The anesthetic consequences were peculiar to the unexpected eti ology of the stenosis and poor general condition of the patient. Minor deta ils like the tracheal tube bevel and ventilatory pattern became vitally imp ortant.