Utility of Video Laryngoscopy in Diagnosing Unanticipated Gastro-Tracheal Fistula Following Intubation for Supratentorial Craniotomy

Gastro-tracheal fistula (GTF) is a rare but serious complication that can occur after esophagectomy. It involves an abnormal connection between the gastric conduit and the trachea that allows gastric contents to enter the respiratory tract. Although GTF is uncommon, it can lead to severe complications such as aspiration pneumonia, respiratory distress, mediastinitis, and sepsis. This case report details the management of an unexpected air leak in a 55-year-old female with a history of esophagectomy who was scheduled for an urgent supratentorial craniotomy. During anesthesia induction, a significant air leak was detected using a McGrath video laryngoscopy (VDL). This tool helped identify the leak and led to further investigation with fiberoptic bronchoscopy, which uncovered a GTF originating from the right main bronchus. The surgical procedure was postponed for a multidisciplinary assessment, and esophageal stenting was later used to manage the fistula successfully. This case highlights the crucial role of VDL in the early detection and management of complex airway issues, demonstrating its importance in enhancing patient outcomes through improved decision-making and interdisciplinary collaboration.