© Springer-Verlag London Ltd 2010
Received: 31 August 2009
Accepted: 11 January 2010
Published: 11 May 2010
OP components are esters, amides or thiol derivatives of phosphoric, phosphonic or phosphinic acids ; by inhibiting acetylcholinestrase, excessive acetylcholine at the cholenergic synaptic level produces OP poisoning. TEF is an abnormal communication between the trachea and esophagus. Esophageal malignancy is the most common cause of TEF in adults; other benign causes are induced by endotracheal tubes, tracheostomies and thoracic surgery; by caustic injuries and esophageal infections like tuberculosis, syphilis and histoplasmocytosis. Ono’s sign , i.e., cough while swallowing, is an important indication of tracheal/bronchial esophageal fistula. In our case, bronchoscopy revealed TEF at the 7 o’clock position, 5 cm from the vocal cord at the junction of the cartlaginous and membranous portion, which corresponded to the lower end of the tracheostomy scar. The incidence of TEF following tracheostomy is less than 1% . To our knowledge, this is the first case report of tracheostomy-induced TEF in a patient with organophosphorus poisoning. Our patient underwent tracheo-esophageal fistulectomy and closure with a free sternocleidomastoid interposition muscle flap. The PEG tube was removed 1 month after surgery.
- Balali-Mood M, Kia Balali-mood (2008) Neurotoxic disorders of organophosphorus compounds and their managements. Arch Iranian Med 11(1):65–89Google Scholar
- Gerzic Z, Rakic S, Randjelovic T (1990) Acquired benign esophagorespiratory fistula: report of 16 consecutive cases. Ann Thorac Surg 50:724–727PubMedView ArticleGoogle Scholar
- Reed MF, Mathisen DJ (2003) Tracheoesophageal fistula. Chest Surg Clin North Am 13(2):271–289View ArticleGoogle Scholar