Abstract
To date, no cases of acquired non-malignant tracheoesophageal fistula (TEF) have been reported in patients with anorexia nervosa (AN). We describe a case of a 28-year-old woman with AN (body mass index=9.6) complicated by cuffed tracheal tube-induced TEF during mechanical ventilation. After emergent surgery for pan-peritonitis, she developed multiple organ dysfunction syndrome (MODS), possibly due to refeeding syndrome and/or severe sepsis. She was orally intubated and received prolonged mechanical ventilation, during which a cuffed tracheal tube-induced TEF formed. We therefore performed high-frequency positive pressure ventilation under massive air leakage permission, and she gradually recovered from aspiration pneumonia and MODS without exacerbation of TEF. Subsequently, she underwent tracheostomy and her trachea was successfully isolated from TEF using a variable-length tracheostomy tube by placing the tip of the tube just upon the carina. This airway isolation was continued for nearly 3 years until her nutritional status improved by enteral nutrition via gastrostomy, and then she underwent surgical closure of TEF and was discharged. Considering the difficulties of the management of TEF with AN under mechanical ventilation, precise control of tracheal cuff pressure and prevention of several risk factors to prolong mechanical ventilation, especially refeeding syndrome, seem to be important.
