The Challenging Complication of Acquired Tracheoesophageal Fistulas: A Case Report

Rationale Acquired tracheoesophageal fistulas (TEFs) are rare and challenging complications, particularly in critically ill patients, with high morbidity and mortality. Patient Concerns A 67-year-old woman presented with respiratory failure, persistent cuff leaks, and complications from nasogastric and feeding tube use. Diagnoses TEFs were identified via esophagoscopy and bronchoscopy, revealing dual mid-esophageal fistulas. Interventions Management included repositioning of the tracheostomy, surgical repair involving tracheal resection and esophageal repair with an omohyoid rotational flap, and extracorporeal membrane oxygenation support during surgery. Outcomes Despite initial postoperative improvement, the patient experienced complications, including an esophageal leak and bleeding, culminating in a transition to comfort care. Conclusion Prevention of acquired TEFs requires vigilant monitoring of device use and pressure. Surgical repair remains complex, with outcomes influenced by patient comorbidities and intraoperative challenges.