Closure of a secondary tracheoesophageal fistula in severe pneumonia using an Amplatzer Duct Occluder II during invasive mechanical ventilation: A case report

Meng Fu; Dongsheng Wang; Jialiang Wang; Qixia Xu; Lejie Cao; Junqiang Zhang

doi:10.1002/ccr3.9470

Closure of a secondary tracheoesophageal fistula in severe pneumonia using an Amplatzer Duct Occluder II during invasive mechanical ventilation: A case report

Clin Case Rep. 2024 Oct 16;12(10):e9470. doi: 10.1002/ccr3.9470. eCollection 2024 Oct.

Authors

Meng Fu^{1

2

3}, Dongsheng Wang¹, Jialiang Wang⁴, Qixia Xu¹, Lejie Cao¹, Junqiang Zhang¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine University of Science and Technology of China (USTC) Hefei Anhui China.
² Science Island Branch, Graduate School of USTC University of Science and Technology of China (USTC) Hefei Anhui China.
³ Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science Chinese Academy of Sciences Hefei Anhui China.
⁴ Institute of Molecular Enzymology, School of Biology & Basic Medical Sciences Suzhou Medical College of Soochow University Suzhou Jiangsu China.

Abstract

Key clinical message: Early and timely closure of secondary tracheoesophageal fistula (TEF) is crucial for critically ill patients. For those requiring invasive mechanical ventilation, the Amplatzer Duct Occluder II (ADO II) can be used as an emergency therapeutic option to rapidly close secondary TEF, providing opportunities for subsequent treatments.

Abstract: Secondary tracheoesophageal fistula (TEF) is a life-threatening condition characterized by high mortality, high recurrence rates, and multiple complications. Reports on the management of secondary TEF in critically ill patients are limited due to the challenges in treatment and the lack of suitable therapeutic options. We report a case of secondary TEF in a 69-year-old male diagnosed with severe pneumonia, whose condition deteriorated rapidly following the onset of TEF. Despite invasive mechanical ventilation, maintaining blood oxygen saturation above 80% was unachievable due to the TEF. Bedside bronchoscopy revealed expansion TEF expansion caused by gastrointestinal fluid reflux and respiratory machine pressure. The TEF was urgently closed using an ADO II device during invasive mechanical ventilation to prevent further deterioration. After the patient's condition stabilized, the ADO II was replaced with a Y-shaped tracheal membrane-covered stent for further TEF management. The patient's condition improved, meeting the criteria for liberation from invasive mechanical ventilation, and bedside chest X-rays revealed a gradual resolution of pulmonary inflammation. Selecting appropriate treatment modalities for early and timely closure of secondary TEF is crucial for critically ill patients. ADO II can serve as a rescue therapy to achieve rapid closure of secondary TEF in critically ill patients requiring invasive mechanical ventilation support, providing opportunities and time for subsequent treatment.

Keywords: Amplatzer Duct Occluder II; airway stenting; bronchoscopy interventional treatment; efficacy; esophageal stenting; tracheoesophageal fistula.