![]() ![]() A tracheo-esophageal fistula was suspected and confirmed by imaging studies and endoscopy. Four weeks after her tracheostomy, contents of nasogastric tube feeding were seen coming through the tracheotomy tube. She was weaned from parental nutrition and was fed through the nasogastric tube. A tracheotomy was performed to assist in the ventilator. The dead fetus and placenta were delivered by emergency caesarian section. The chest X-ray and CT scan of the chest were suggestive of aspiration pneumonia. An urgent U/S of the abdomen showed a full term uterus and no fetal movements. ![]() The initial diagnosis on admission was pre-eclampsia, intrauterine death of child, pneumonia and septicemia. The chest was full of bilateral crepitations. Her abdomen was tense, tender, and had a scar from previous caesarian section and yet no fetal heart sounds were audible. On examination, the patient was toxic, febrile, dyspnoic. A 35 year old full term multipara female was referred from a neighboring country with a history of obstructed labor for the last three days. A combined laparoscopic and endoscopic technique was used to create a drainage gastrostomy and feeding jejunostomy. In this patient, percutaneous approach alone was not possible due to past and present abdominal surgery and obesity. There are several methods of diversion of gastric contents and for creating feeding jejunostomy including percutaneous, endoscopic, radiological, laparoscopy and laparotomy, tailored according to the clinical situation and the available expertise. A drainage gastrostomy and feeding jejunostomy is often required to divert the gastric contents away from the fistula and for nutrition. The first stage of treatment involves the diversion of salivary and gastric contents away from the fistula site, improving the nutritional status and control of sepsis. Patients of TEF are usually very critically ill and prone to repeated aspiration and pneumonia. ![]() tracheo-esophageal Fistula (TEF) is a rare but serious complication of prolonged endotracheal intubation. ![]()
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