School of Medicine and Health Sciences Poster Presentations

Title

Delayed Complication of Tracheocutaneous Fistula Closure with Severe Compromising Subcutaneous Emphysema

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

Tracheocutaneous Fistula, Subcutaneous emphysema, Tracheostomy, Surgical complications, Pediatrics

Publication Date

Spring 5-1-2019

Abstract

Tracheocutaneous fistula (TCF) is commonly seen in pediatric patients with long term tracheostomy following decannulation. The fistula may be surgically closed by a variety of techniques. We report a significant complication of TCF excision in a 4 year old male with a history of restrictive lung disease due to a giant omphalocele who had been tracheostomy dependent since infancy. He was decannulated at age 3, and one year after decannulation had a persistent 3mm TCF. He underwent surgery to repair the TCF with excision of the fistula tract and intended closure by secondary intention. On post-operative day 2 the patient rapidly developed profound subcutaneous emphysema of the face, neck, arms and chest, as well as pneumomediastinum. Due to the rapid onset there was concern that swelling may compromise the airway leading to urgent intubation. He was extubated after 2 days as the swelling resolved and discharged from the hospital on post-operative day 7 in stable condition. At follow up he had complete resolution of subcutaneous emphysema as well as complete closure of the TCF. Subcutaneous emphysema is a rare complication of TCF repair. We discuss the main methods of TCF closure with the indications, benefits, and complications of each. Management of subcutaneous emphysema is also discussed along with the lessons learned from this case.

Open Access

1

Comments

Presented at Research Days 2019.

This document is currently not available here.

Share

COinS
 

Delayed Complication of Tracheocutaneous Fistula Closure with Severe Compromising Subcutaneous Emphysema

Tracheocutaneous fistula (TCF) is commonly seen in pediatric patients with long term tracheostomy following decannulation. The fistula may be surgically closed by a variety of techniques. We report a significant complication of TCF excision in a 4 year old male with a history of restrictive lung disease due to a giant omphalocele who had been tracheostomy dependent since infancy. He was decannulated at age 3, and one year after decannulation had a persistent 3mm TCF. He underwent surgery to repair the TCF with excision of the fistula tract and intended closure by secondary intention. On post-operative day 2 the patient rapidly developed profound subcutaneous emphysema of the face, neck, arms and chest, as well as pneumomediastinum. Due to the rapid onset there was concern that swelling may compromise the airway leading to urgent intubation. He was extubated after 2 days as the swelling resolved and discharged from the hospital on post-operative day 7 in stable condition. At follow up he had complete resolution of subcutaneous emphysema as well as complete closure of the TCF. Subcutaneous emphysema is a rare complication of TCF repair. We discuss the main methods of TCF closure with the indications, benefits, and complications of each. Management of subcutaneous emphysema is also discussed along with the lessons learned from this case.