Repair of complex acquired tracheoesophageal fistula guided by 3D printing: a case report

3D-printed (3DP) models have been used to for complex surgical simulation and planning in multiple surgical contexts, but never acquired tracheoesophageal fistulas (TEF). A 10-month-old previously healthy female infant presented with 3 days of persistent fevers and worsening respiratory distress. A 2-cm button battery found in the esophagus on chest x-ray was urgently removed by rigid endoscopy. A remaining plaque-like tracheal lesion was later identified on rigid bronchoscopy as a 2x1.5cm TEF. Using the computer-assisted design software Mimics (Materialise v28.06, Leuven, BE) a 1:1 anatomical 3DP replica of the patient’s anatomy was constructed using a computed tomography scan and printed using a polyjet resin printer (Stratasys J750, Minneapolis, MN). The model was used to plan the multi-disciplinary repair. The trachea and esophagus were mobilized through a median sternotomy while on cardiopulmonary bypass. The 270-degree esophageal defect was repaired with a partial circumference esophageal anastomosis. The tracheal defect required posterior reconstruction and end-to-end anastomosis. An endotracheal tube was positioned superior to the anastomosis via intraoperative bronchoscopy and a mediastinal chest tube was placed. She was monitored with daily bronchoscopies until extubation on post-operative day 7. A contrast esophagram on day 18 noted no strictures/leaks. The only postoperative complications were mediastinitis treated with antibiotics and left vocal chord hypomobility treated with injection laryngoplasty on post-operative day 23 before discharge home on day 36. She remained grossly asymptomatic through her first year of follow-up with unremarkable 1-year follow-up bronchoscopy. 3D printed models may be helpful in the preoperative planning of complex tracheoesophageal reconstruction.