2020 Volume 56 Issue 6 Pages 949-954
Laryngotracheal separation (modified Lindeman’s procedure) is a procedure that can prevent intractable aspiration in neurologically impaired patients. We experienced treating a rare case of tracheocutaneous fistula caused by a foreign body nine years after a modified Lindeman’s procedure. The patient was a 12-year-old girl with Miller–Dieker syndrome. We performed fundoplication with gastrostomy for gastroesophageal reflux disease (GERD) and dysphasia at 1 year of age, and a modified Lindeman’s procedure for chronic respiratory failure at 2 years of age. A 1-mm-diameter hole with respiratory saliva outflow was observed in the upper tracheostoma at 11 years and 4 months of age. Percutaneous fistula imaging showed a fistula that connected the blind end of the trachea to the hole, and a foreign body was observed at the blind end of the trachea. We removed the foreign body, but the fistula was not closed. Next, we sutured the fistula and performed gauze compression, but the saliva outflow persisted. Therefore, cyanoacrylate filling was performed, after which the saliva outflow improved and the fistula closed. Our search of the relevant literature revealed only one case in Japan in which a tracheal blind foreign body was found after a modified Lindeman’s procedure. There have been no reports implicating a trachea-blind foreign body as the cause of fistula formation. Oral care should be considered to prevent complications in patients undergoing laryngotracheal separation. Cyanoacrylate filling was an effective treatment.
