Double mirrors teamed up to block the big hole
Multi-disciplinary cooperation showed supernatural powers
The Children's Hospital of Heavy Medicine successfully treated a child with a huge esophagotracheal fistula!
"Thank you to the doctors at Children's Hospital !" Recently, a thank-you call brought back the memories of the ENT and gastroenterologists at the Children's Hospital Affiliated to Chongyi Medical College.
Chen Chen (pseudonym), a 1-year-old from Guizhou, accidentally ate the button battery while playing. Since his parents were not around at the time, he did not know about it. One week later, Chen Chen developed hoarseness, cough, low fever, and phlegm in the throat. She went to the local outpatient clinic to complete a chest X-ray to indicate esophageal foreign body. The doctor performed esophagoscopic foreign body removal under general anesthesia. The battery incarcerated area (14cm away from the incisors) of the forearm and both sides of the esophagus mucosa had circular burns, involving part of the muscle layer.” A gastric tube was placed outside the hospital and was urgently transferred to the Department of Gastroenterology, Yuzhong Hospital, Affiliated Children's Hospital of China, for further treatment.
On the night of admission, Chenchen was in critical condition, with choking, labored breathing, moaning, cyanosis around the lips, and decreased oxygen saturation under oxygen inhalation. After asking ICU for emergency consultation and active treatment, Chenchen's cyanosis situation improved. After emergency chest CT scan and airway reconstruction examination, the doctor found that the middle and upper part of the esophagus of the child was locally narrowed, which was suspected to be connected with the trachea, and an esophagotracheal fistula was suspected.
In order to find the "culprit", the respiratory doctor examined through fiberoptic bronchoscope and the gastroenterologist examined through gastroscope, all of which confirmed the existence of esophagotracheal fistula in the child. The doctor immediately implanted the child with a nasogastric feeding tube to supplement enteral nutrition, actively fight infection, and support treatment.
Huge esophagotracheal fistula (after placing a nasojejunal feeding tube)
Due to Chen Chen's repeated coughing after pumping, flushing, phlegm in the throat, wheezing, intermittent fever, lung infection, aggravated, etc. In this case, the Department of Gastroenterology immediately initiated a multidisciplinary consultation of the whole hospital, together with experts from the Department of Otolaryngology, Head and Neck Surgery, Department of Pulmonology, Department of Thoracic and Cardiovascular Surgery, Department of Infectious Diseases, Department of Anesthesiology, Department of Nutrition, Department of Radiology, and Department of Critical Care Medicine. Discuss the condition. Chenchen's tracheoesophagus has formed a huge fistula of about 4cm (the proximal end of the fistula is 12cm away from the incisors, and the distal end is 16cm away from the incisors), which is equivalent to a section of the esophagus and trachea without a "load-bearing wall", suggesting liquefaction caused by button batteries. Necrosis continues to increase, and the fistula is adjacent to the aorta. If the aorta is corroded, life is at risk at any time. Due to the difficulty of enteral nutrition and the risk of exacerbation of pneumonia and , experts recommend temporary total intravenous nutrition for children, and jejunal tube feeding through laparoscopic fistula if necessary.
For the huge esophagotracheal fistula, if traditional thoracotomy is used to repair it, the surgical trauma is very large, and the risk of postoperative complications of esophageal stricture and tracheomalacia is particularly high, and these complications require a long treatment process. If a rigid endotracheal stent is placed for treatment, the surgical trauma is small, but the postoperative metal stent may damage the surrounding large blood vessels, resulting in life-threatening hemorrhage, and the removal of the metal stent is difficult.
Tang Xinye, Deputy Director of Otolaryngology Head and Neck Surgery, after careful consideration, proposed a new plan for Chen Chen, implanting a T-shaped tube (silicone stent) through the tracheotomy to seal the fistula. The tube crawls and grows, the trachea and esophagus heal at the same time about 1 month after the operation, and the T tube does not damage the surrounding vital organs, so it is relatively simple to remove the T tube, avoiding traditional thoracotomy and placing metal stents.
After thorough preoperative preparations, the otolaryngology head and neck surgery team led by Deputy Director Tang Xinye and the digestive endoscopy team led by Director Zhan Xue of the Department of Gastroenterology worked hand in hand with the collaboration of multiple departments such as the Department of Anesthesiology and the Department of Critical Care Medicine. Nasojejunal feeding tube + T-tube (silicone stent) placement surgery under the guidance of gastroscope .
T-tube placement
T-tube (silicone stent) placement, as a new and difficult throat surgery, poses a great challenge to anesthesiologists. These children have varying degrees of gas before surgeryLaryngeal stenosis and dyspnea and performance, the symptoms of laryngeal obstruction after anesthesia may be further aggravated; the operation area of the larynx is special, the surgeon and the anesthesiologist need to share the airway, the surgeon performs surgical operations in the airway, and the anesthesiologist needs to It is extremely difficult for anesthesiologists to control breathing and maintain oxygenation through the airway. It is necessary to maintain sufficient depth of anesthesia, ensure adequate oxygen supply for children, and cooperate with the operation of the surgeon.
After the T-tube was placed, after fully evaluating the patient's condition, understanding the operation process, communicating with the surgeon repeatedly, and improving the anesthesia plan, Dr. Liu Jianxia, the head of the airway management team of the Department of Anesthesiology, cooperated with the surgeon to complete the operation safely. The signs were stable and the postoperative recovery was comfortable.
After the operation, Chen Chen received meticulous treatment and care in the ICU and ENT ward. The gastroenterology department maintained the situation of the nasojejunal tube and adjusted the nutritional support plan for Chen Chen in real time. After overcoming multiple difficulties such as infection, thrombosis, detachment and blockage of the nasojejunal tube, a miracle happened. 4 months after the operation, Chen Chen re-examined the endoscopy, and the huge esophagotracheal fistula had completely healed. The doctor pulled out the T-tube for Chen Chen and closed the airway incision. The surgical effect was very good. At present, Chen Chen can eat normally, and can grow up healthily like a normal child in the future.
Re-examination in March after operation
Re-examination in April after operation, the fistula is completely healed
According to literature review, Chen Chen is currently the youngest and the largest completely cured case of esophagotracheal fistula in China. Patients with esophagotracheal fistula caused by mistakenly ingesting batteries or other corrosive substances often occur. The combination of double mirrors and multidisciplinary cooperation provides a new treatment for children with esophagotracheal fistula, especially those with huge and refractory esophagotracheal fistula. treatment strategy.
Source: Children's Hospital Affiliated to Chongqing Medical University
Release: Sunshine
