Anesthetic management of a gross type C tracheoesophageal fistula by balloon catheter via tracheostoma in an infant with trisomy 18: A Case Report.

RATIONALE: Gross Type C congenital esophageal atresia is associated with tracheoesophageal fistula (TEF). Perioperative airway management, including prevention of aspiration of gastric contents, is important. Generally, the TEF is blocked by 1-lung intubation of the dependent lung, or directly by insertion of a balloon catheter. This case report describes successful management of TEF by insertion of a balloon catheter via tracheostoma in an infant with a difficult airway. PATIENT CONCERNS: A boy with trisomy 18 underwent esophageal banding and gastrostomy for Gross Type C congenital esophageal atresia on postnatal day 3. Tracheostomy was performed on day 49, and definitive surgery for TEF was scheduled on day 83. DIAGNOSES: The boy was diagnosed with Gross Type C congenital esophageal atresia shortly after birth. INTERVENTIONS: The patient was re-intubated orotracheally in the NICU. Oral insertion of a 4Fr Fogarty catheter to block the TEF was difficult. Insertion through the available tracheostoma was easier. OUTCOMES: We confirmed that the catheter could be guided to the TEF entrance using a bronchoscope, and the balloon was expanded to block the TEF. During surgery, there were no problems with airway management. LESSONS: In the management of TEF in children after tracheostomy, if oral insertion of the balloon catheter proves difficult, insertion via the tracheostoma may be effective.