A Catheter-Guided Technique for Second Branchial Cleft Fistula Excision in Infants: A Case Report.

Abstract

Introduction: Second branchial cleft (SBC) fistulas are the most common branchial cleft anomalies and typically present in infancy or early childhood. While complete surgical excision is the standard treatment, surgical challenges in younger children arise because of narrower fistula tracts and inadequate visualization, which increase the risk of complications and recurrence.

Case presentation: We report the case of a 6-month-old boy with an SBC fistula who presented with persistent mucoid discharge from a right cervical orifice. Fistulography confirmed the presence of a complete SBC fistula. At 9 months of age, a fistulectomy was performed using a 28-gauge peripherally inserted central venous catheter (PICC) as a guide to identify the entire fistula tract. The catheter facilitated the precise identification of the fistula tract, saline irrigation, dissection under endoscopic guidance, and confirmation of the internal end by creating a knot at the catheter tip. The tract was excised completely without any complications. The patient recovered uneventfully and showed no recurrence at 6 months postoperatively.

Conclusions: Complete surgical resection remains the gold standard for SBC fistulas. However, anatomical challenges in younger children limit the applicability of various intraoperative tools and techniques. The use of a small-diameter catheter as a guide to identify an entire fistula tract is a valuable approach that overcomes these challenges, enhances surgical precision, and reduces the risk of complications and recurrence.