Lagrotta G, Ayad M, Butt I, Danckers M. Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report. World J Crit Care Med 2022; 11(5): 335-341 [PMID: 36160935 DOI: 10.5492/wjccm.v11.i5.335]
Corresponding Author of This Article
Gustavo Lagrotta, DO, Doctor, Graduate Medical Education, Pulmonary Disease, Aventura Hospital and Medical Center, 20900 Biscayne Blvd., Aventura, FL 33180, United States. gustavo.lagrottasaavedra@hcahealthcare.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2022; 11(5): 335-341 Published online Sep 9, 2022. doi: 10.5492/wjccm.v11.i5.335
Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report
Gustavo Lagrotta, Mina Ayad, Ifrah Butt, Mauricio Danckers
Gustavo Lagrotta, Graduate Medical Education, Pulmonary Disease, Aventura Hospital and Medical Center, Aventura, FL 33180, United States
Mina Ayad, Department of Internal Medicine, Aventura Hospital and Medical Center, Aventura, FL 33180, United States
Ifrah Butt, Department of Gastroenterology, Aventura Hospital and Medical Center, Aventura, FL 33180, United States
Mauricio Danckers, Division of Pulmonary and Critical Care Medicine, Aventura Hospital and Medical Center, Aventura, FL 331380, United States
Author contributions: Danckers M contributed conceptualization, writing original draft preparation and follow up revisions, image acquisition and editing, illustration preparation and data verification; Lagrotta G contributed writing original draft, image review and verified data; Ayad M contributed reviewing, data and image acquisition; Butt I contributed reviewing.
Informed consent statement: Written consent for publication was obtained from the patient health care proxy.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gustavo Lagrotta, DO, Doctor, Graduate Medical Education, Pulmonary Disease, Aventura Hospital and Medical Center, 20900 Biscayne Blvd., Aventura, FL 33180, United States. gustavo.lagrottasaavedra@hcahealthcare.com
Received: January 20, 2022 Peer-review started: January 20, 2022 First decision: April 13, 2022 Revised: May 29, 2022 Accepted: July 31, 2022 Article in press: July 31, 2022 Published online: September 9, 2022 Processing time: 229 Days and 3.8 Hours
Abstract
BACKGROUND
Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.
CASE SUMMARY
We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt. He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit. The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest. Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.
CONCLUSION
The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression. We aim to illustrate pitfalls in the endoscopic examination and provide further awareness on critical care monitoring and management strategies to reduce its morbidity and mortality.
Core Tip: Trachea-esophageal and broncho-esophageal in the setting of caustic ingestion is an unusual complication associated with high morbidity and mortality. Close monitoring of the gastrointestinal tract patency and motility is critical to avoid gastric distention and large aspiration events with detrimental consequences. Although there is no general consensus on the initial approach to patients with fistula formation, our case proposes serial esophagogastroduodenoscopy and flexible bronchoscopy for at least 6 mo as well as a low threshold for surgical referral when progression of disease or new findings are encountered.
