Anesthetic management of a neonate with laryngotracheoesophageal cleft and tracheoesophageal fistula

摘要

Laryngotracheoesophageal cleft (LTEC) is an extremely rare congenital anomaly characterized by an absence of all or a part of the tracheoesophageal septum producing an abnormal communication between the trachea and esophagus, and is often difficult to be diagnosed. A 2-day-old male baby was tentatively diagnosed as tracheoesophageal fistula type Gross C, and underwent gastrostomy. The trachea was intubated before anesthetic induction. When a balloon of gastrostomy catheter was inflated, the lung could not be ventilated. After extubation of endotracheal tube and removal of gastrostomy catheter, the lung could be ventilated with mask. When endotracheal tube was intubated again, the lung could not be ventilated at all. Thus the surgery was performed under mask ventilation. Endoscopic examination performed 2 weeks later gave diagnosis of LTEC type 3. It is likely that the endotracheal tube might have been advanced into the end of the esophagus due to absence of the tracheoesophageal septum. In spite of a rare disease, LTEC should be considered as an extreme case of transesophageal fistula with a high risk of difficult airway.