Fogarty Catheter Placement for Subglottic H-Type Tracheoesophageal Fistula via a Supraglottic Airway: A Case Report

TL;DR

A new method using a supraglottic airway device successfully placed a catheter for a difficult tracheoesophageal fistula in a 2-month-old infant.

Contribution

A novel technique for Fogarty catheter placement in subglottic H-type TEF using a supraglottic airway device is described.

Findings

A supraglottic airway device enabled successful identification and catheter placement for a subglottic TEF.

The method was safe and effective, with no adverse events during the procedure.

The patient recovered well and was discharged after 39 postoperative days.

Abstract

Surgery for tracheoesophageal fistula (TEF) often necessitates the insertion of a Fogarty catheter (FC) to assist the surgeon in identifying the fistula. However, when the TEF is located close to the glottis, bronchoscopic identification of the TEF and FC insertion can be particularly challenging. A 2-month-old female infant exhibited frequent apneic episodes during feeding from postnatal day 5. A subsequent contrast swallow study and bronchoscopy led to the diagnosis of H-type esophageal atresia. Surgical ligation of the TEF was performed on Day 64 of life. Under general anesthesia induction with endotracheal intubation, bronchoscopic visualization of the TEF was attempted before commencing surgery. However, the subglottic location of the TEF made its identification difficult. The TEF was subsequently successfully identified using a supraglottic airway device in combination with positive pressure ventilation. Thereafter, an FC was inserted through the supraglottic device, which was later replaced by tracheal intubation. No adverse events were observed during the procedure. The patient was extubated on postoperative day (POD) 6 and was discharged on POD 39. The method described in this report was effective for efficient insertion of the FC into the subglottic TEF and might contribute to safer and more reliable surgical performance.

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