PMC9811173_01
Postoperative contrast examination of the esophagus shows no apparent anastomotic leakage but anastomotic stenosis.
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F1
However, asymptomatic anastomotic stenosis was observed (Figure 1), and the patient was discharged on postoperative day (POD) 31 without any complications.
PMC9811173_02
A contrast examination of the esophagus 2 months after the primary surgery shows an RTEF at the proximal site of anastomosis (arrowhead). The TEF was closed with sutures and the placement of a pleural patch (arrow) at the first RTEF repair. A contrast examination of the esophagus after the first RTEF surgery shows no apparent recurrent TEF. RTEF, recurrent tracheoesophageal fistula.
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F2
At the time, a contrast examination of the esophagus showed an RTEF (Figure 2: first RTEF). The RTEF was closed with a 4-0 absorbable braided suture with the placement of a pleural patch (Figure 2: first RTEF repair) after confirming the esophageal suture line and that the trachea and esophagus were not attached. The anastomotic stenosis was not simultaneously treated since it was asymptomatic, and a contrast examination of the esophagus on POD 6 showed no apparent RTEF (Figure 2: postoperative image of the first RTEF).
PMC9811173_03
A contrast examination of the esophagus shows the second RTEF at the exact location of the first RTEF (arrowhead). During the second RTEF repair, the TEF was closed with sutures with a fascia lata graft (arrow). RTEF, recurrent tracheoesophageal fistula.
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F3
A contrast examination of the esophagus showed a second RTEF (Figure 3: second RTEF). Hence, the patient underwent a thoracoscopic RTEF repair with sutures and a fascia lata graft (Figure 3: second RTEF repair).
PMC9811173_04
A contrast examination of the esophagus shows the third RTEF at the exact location of the first and second RTEFs (arrowhead). RTEF, recurrent tracheoesophageal fistula.
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F4
A contrast examination of the esophagus at 7 months old showed a third RTEF (Figure 4).
Bronchoscopy shows the fourth RTEF with a big hole (arrowhead). Chest radiography shows severe mediastinitis and right pneumonia. RTEF, recurrent tracheoesophageal fistula.
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F5
At the time, a bronchoscopy showed a fourth RTEF (Figure 5: fourth RTEF). The patient's condition gradually worsened, developing mediastinitis with DIC, shock liver, and respiratory failure (Figure 5: chest radiography).
PMC9811173_05