Man heals from rare fistula condition that made him choke on water

Pune: After days of persistent cough and a sense of choking on water, a 32-year-old man was diagnosed with tracheo-esophageal fistula — a condition primarily observed as a congenital defect in newborn infants. Its occurrence in an adult is considered an exceptionally rare phenomenon, said an expert.Some doctors said the rare congenital condition gets diagnosed within two years of birth, but the man managed to survive it into adulthood.General and laproscopy surgeon at Mhaske hospital Dr Chetan Mhaske, who performed the surgery, said, “The man appeared physically robust and was able to perform daily activities without difficulty. When a basic task like sipping water became distressing, he finally came to our hospital. We examined him and performed a gastroscopy immediately. The diagnosis of a tracheo-esophageal fistula was shocking. Simply put, it is an abnormal passage formed between the food pipe (esophagus) and the windpipe (trachea).”Mhaske said that due to the condition, whenever the man drank water, it would flow directly from the food pipe into the windpipe and into the lungs — causing a sensation of suffocation. “The condition could have led to a severe lung infection (pneumonia) and potentially resulted in the patient’s death, had it not been treated in time. The diagnosis was confirmed conclusively through a CT scan and bronchoscopy.”The patient was admitted on Jan 21 and underwent the surgery the next day. The surgical procedure was as complicated as the ailment is rare, said oncosurgeon Dr Mahesh Pawar.Pawar said managing the tracheo-esophageal fistula was extremely challenging, because the patient had a previous history of accidental corrosive substance ingestion — which had caused severe chronic inflammation and dense adhesions in the neck region. The fistula tract and the esophagus were densely stuck to the trachea, making identification and separation exceptionally delicate.“We carefully separated the esophagus from the trachea, while preserving the paper-thin posterior wall of the trachea. Any additional injury to this fragile area could have necessitated a temporary or even permanent tracheostomy — which carries long-term morbidity, especially in a young patient. Another major challenge was safely dissecting and preserving the important neck vessels that were adherent due to chronic inflammatory changes. After complete separation, the esophagus was repaired in multiple layers and the posterior tracheal wall was reconstructed with surgical precision,” Pawar added.Plastic surgeon Dr Amit Mule said, ”We were able to successfully restore both structures while avoiding tracheostomy and its associated complications. During the surgery, merely closing the perforation (fistula) was not sufficient. We provided additional structural reinforcement to the area by utilising a muscle flap to ensure the site would not reopen.”The windpipe and the food pipe were successfully separated and repaired after hours of tireless effort. The man’s health showed remarkable improvement within just a few days of the surgery and he was discharged soon. A CT scan revealed that the dangerous fistula had closed completely, ensuring a routine life for the man by March 6. He showed no signs of recurrence during his last follow up on May5.