The use of heterologous bovine pericardium in the surgical treatment of large tracheo-oesophageal fistulas and dilaceration of the membranous wall of the trachea

Abstract

The tracheo-oesophageal fistula is a severe condition endangering the patients’ live. The main cause of this condition is the prolonged ventilation. The purpose of this paper is to present an innovative technique in treating this affection.

CASE REPORT: We present the case of a 32 years old female patient with multiple trauma due to traffic accident. The patient was hospitalized with the diagnosis of brain injury, subarachnoid hemorrhage, and fractured femur. After 11 days of mechanical ventilation and intubation via endotracheal route, the patient was diagnosed with a large (7x3 cm) tracheo-oesophageal fistula with dilaceration of the membranous wall of the trachea. A cervical and right thoracic approach was performed to repair the tracheo-oesophageal fistula. The reconstruction of the membranous wall of the trachea was performed by using heterologous bovine pericardium patch, and the of the esophageal defect using single-layer suture protected by a heterologous bovine pericardium patch. The postoperative evolution was favorable, the patient being discharged 22 days postoperatively and in good health after 6 months.

To our knowledge this is the first reported case regarding the use of two heterologous bovine pericardium in the surgical treatment of large tracheo-oesophageal fistula with dilaceration of the membranous wall of the trachea to reconstruct the membranous wall of the trachea and to protect the esophageal suture.