A 74-year-old male has been intubated for respiratory failure developing two weeks after oesophagectomy for adenocarcinoma. He has no other significant past medical history. After intubation, an audible air leak was apparent. Urgent bronchoscopy demonstrated a fistula between the proximal left main bronchus and the oesophago-gastric anastomosis.
Outline the immediate management priorities and the priorities for the ongoing ICU management of this patient.
This question is identical to Question 23 from the second paper of 2019.
As usual, the management can be divided into "supportive" and "specific".
Specific management resembles the oesophageal perforation options mentioned above, with the exception of all the bronchoscopic stuff:
Hasan, Shafqat, Ali NA Jilaihawi, and Dhruva Prakash. "Conservative management of iatrogenic oesophageal perforations—a viable option." European journal of cardio-thoracic surgery 28.1 (2005): 7-10.
Biancari, F., et al. "Treatment of esophageal perforation in octogenarians: a multicenter study." Diseases of the Esophagus 27.8 (2014): 715-718.
Spalding, Alanson R., Donald P. Burney, and Robert E. Richie. "Acquired benign bronchoesophageal fistulas in the adult." The Annals of thoracic surgery 28.4 (1979): 378-383.
Kalmár, Katalin, et al. "Non-malignant tracheo-gastric fistula following esophagectomy for cancer." European journal of cardio-thoracic surgery 18.3 (2000): 363-365.
Lolley, David M., et al. "Management of malignant esophagorespiratory fistula." The Annals of thoracic surgery 25.6 (1978): 516-520.
Shamji, Farid M., and Richard Inculet. "Management of malignant tracheoesophageal fistula." Thoracic surgery clinics 28.3 (2018): 393-402.