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Successful salvage right upper lobectomy and flap repair of trachea-esophageal fistula due to severe necrotizing pneumonia

^a Department of Thoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, CB23 8RE, UK
^b Anaesthetics and Intensive Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, CB2 0QQ, UK
^c Plastic and Reconstructive Surgery and Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, CB2 0QQ, UK

*Corresponding author. Tel.: +441480 364887; fax: +441480 364583.

E-mail address: aman.coonar{at}papworth.nhs.uk (A. Coonar).

A 55-year-old previously well man developed a severe pneumonia. Endoscopy found tracheal and esophageal fistulae communicating with the right lung and pleural space. Bilateral main bronchi intubation was required. Emergency surgery was performed with a latissimus dorsi and serratus anterior muscle flap to close the tracheal and esophageal fistulae. The right upper lobe was found to be destroyed and resected. It was possible to salvage the patient who was discharged home despite challenging anesthetic and surgical circumstances.

Key Words: Trachea-esophageal fistula; Necrotizing pneumonia; Selective endobronchial intubation; Pedicled muscle flap