Airway management in pediatric tracheoesophageal fistula repair with tracheostomy and stents: a case report.

Abstract

Background: The airway management of complex tracheoesophageal fistula repairs in pediatric patients presents unique challenges, particularly in cases involving pre-existing tracheostomy and tracheal stenting. The combination of restricted mouth opening, altered airway anatomy secondary to tracheal stents, and the presence of a tracheostomy creates significant technical obstacles in establishing effective one-lung ventilation during thoracoscopic procedures. This report describes a novel and successful one-lung ventilation strategy in a complex pediatric case, demonstrating the feasibility of one-lung ventilation under these challenging anatomical constraints.

Case presentation: A 5-year-old patient presenting with iatrogenic tracheoesophageal fistula secondary to corrosive airway injury underwent thoracoscopic surgical repair, with a complex clinical course marked by tracheal stenosis, tracheal stent placement, and tracheostomy. Successful intraoperative one-lung ventilation was achieved through flexible electronic bronchoscopy-guided orotracheal intubation with a 4.0-mm endotracheal tube, followed by precise positioning of a disposable bronchial blocker in the right main bronchus.

Conclusions: Transoral use of a bronchial blocker combined with an existing tracheostomy tube demonstrated technical feasibility for achieving pulmonary isolation in children with tracheal stent and tracheostomy. However, the generalizability of this approach requires further validation through larger cohort studies.