Introduction:
Etiology of tracheoesophageal fistula is commonly congenital due to
failure of proper embryonic lung bud branching, resulting in lateral
septation of the foregut into the esophagus and trachea. Clinically, TEF
severity relates to oxygenation and aspiration pneumonia from gastric
reflux.
Acquired TEF is rare. Battery ingestion has recently increased in
incidence, presenting asymptomatically or with nonspecific symptoms of
fever, poor feeding, and dyspnea. The battery establishes an electrical
circuit within the esophagus producing hydroxide ions at the negative
pole forming alkali burns that perforate the esophagus and create a
TEF.2 Treatment of battery swallow-induced TEF
requires immediate surgery, preferably within two hours to minimize
friability, tissue necrosis, fistula enlargement, tracheobronchial
contamination, sepsis, and nutritional problems.3 We
discuss the diagnosis, anesthetic approach, and surgical corrections of
battery swallow-induced TEF (Figure 1) in a pediatric patient.