Tracheoesophageal fistula

However, she is now noted to have recurrent episodes of desaturation with meals.

Due to the association of the desaturation with meals, besides dysphagia, a tracheoesophageal fistula should be considered.

This can be diagnosed with flexible bronchoscopy and treated with endoscopic or surgical interventions.

A tracheoesophageal fistula is a communication between the posterior wall of the trachea and the anterior wall of the esophagus.

Prolonged pressure on the posterior membranous wall of the trachea from a tracheostomy balloon results in ischemic necrosis, tissue breakdown, and subsequent fistula formation.

Risk factors include high airway pressures, prolonged cuffed tracheostomy tube, high cuff pressures, excessive trach movement, steroid use, type 1 diabetes, chronic hypoxia, poor nutritional status, hypotension, anemia, sepsis, the presence of a nasogastric tube, and GERD.