oa Wits Journal of Clinical Medicine - Tracheoesophageal fistula post ingestion of oxtail bone - case report

Volume 2 Number 2
  • ISSN : 2618-0189
  • E-ISSN: 2618-0197



Tracheoesophageal fistula (TOF) in the paediatric group is a result of defective embryogenesis. It affects 1/3000– 4500 births and is the most common cause of TOF.(1) The acquired (non-malignant) cause is rather rare and has multiple aetiologies that comprise instrumentation (endoscopy), ingestion of foreign body or corrosive, infection (mainly tuberculosis), trauma, prolonged intubation and iatrogenic (during tracheostomy). The incidence is so rare that it cannot be quantified. When we consider any of these acquired aetiologies in isolation, the incidence approaches 0%. The clinical presentation depends on the underlying aetiology but when the fistula is established, it invariably includes the signs and symptoms related to the passage of oesophageal contents to the airway such as choking, lung infection and coughing. The resultant severe sepsis and malnutrition can lead to mortality if appropriate management is not initiated timeously. The end point of the management is to restore the patient physiology through reestablishment of normal anatomy and providing supportive care. Available options include endoscopy, open surgery (collar incision or right thoracotomy) and even video-assisted thoracoscopy. TOF post-trauma will most likely require surgical approach as dictated by the clinical presentation. Severe case may benefit from staged procedure to optimize the patient’s condition. Endoscopy management (clipping, stenting) may be the initial approach in TOF from foreign body ingestion. In this case report, we would like to discuss a very rare cause of TOF due to the ingestion of oxtail bone.

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