Oeso-Tracheal Fistula on a Forgotten Denture: Diagnosis and Management through an Unusual Clinical Case

Case Report

Austin J Clin Case Rep. 2016; 3(5): 1107.

Oeso-Tracheal Fistula on a Forgotten Denture: Diagnosis and Management through an Unusual Clinical Case

Razafimanjato Narindra NM¹*, Rakotoarisoa AJ¹, Ramanampamonjy RM² and Rakotovao HJ¹

¹Department of Thoracic Surgery, CHU Ampefiloha, Madagascar

²Department of Gastroenterology, CHU Befelatanana, Madagascar

*Corresponding author: Razafimanjato Narindra Njarasoa Mihaja, Department of Thoracic Surgery, CHU Ampefiloha, Madagascar

Received: November 06, 2016; Accepted: December 27, 2016; Published: December 30, 2016


If ingestion of a foreign body (EC) is a classic and often crash early diagnosis in children, a severe complication type revealing oesophageal-tracheobronchial fistula is usually the preserve of adults. These are rare clinical situations, but always complex. We report a clinical case of an FTO on dentures forgotten in a Malagasy 46 years revealed by chronic respiratory and digestive symptoms evolving for three years. Treatment was exclusively surgical marked by the failure of a flap interposition costal we oblige to indicate esophageal coloplasty after esophageal bi-exclusion. A complicated surgery with 9.3% mortality but it is still the only suitable technique to our technical platform in Madagascar.

Keywords: Bronchoscopy; Foreign body; Chronic dysphagia; Endoscopy; Esophageal-tracheal fistula; Esophageal perforation; Thoracotomy


The Oeso-Tracheal Fistula (OTF) is defined as communications between the esophagus and the trachea or bronchi. These clinical situations are rare, though always complex; require an early diagnosis and a surgical treatment at an optimal time [1]. We report a new case of an OTF on a forgotten denture in a Malagasy adult. Through this observation, which to our knowledge has never been described previously, the authors discuss through a literature review the diagnostic features and therapeutic difficulties encountered while dealing with this type of complication, which is sometimes serious in precarious environment.

Case Presentation

Mr. AH 46 years, of Malagasy origin, was hospitalized for a chronic dysphagia that lasted for three years. Recently, dysphagia was becoming more and more marked for semi-liquid foods with the feeling of “something stuck on it.” The examination had revealed the circumstances of the initial accident of which no detail had been overlooked. Our patient had been invited to an end of the year party with a hearty and watered meal. In the night, he displayed a feeling of choking, breathing and coughing spasms. The acute manifestations yielded rapidly. The next morning, he noticed the disappearance of his dentures. In the following years, a painful wallowing difficulty, a sensation of false passage with bronchorrhea and dysphagia followed by a vomiting, settled gradually to become complete and accompanied by a significant weight loss. These symptoms have been labeled as an infection of the upper respiratory tract treated with antiinflammatory and antibiotics which evolve in a rather favorable but ephemeral way. The standard radiographic examination of the chest, the only examination available in his region, which had been practiced repeatedly, was considered normal. He was subsequently referred to our center and benefited from an esophageal and bronchofiber scope which found out an oeso-tracheal fistula on an obstacle to 25 cm from the dental arch. The biopsy showed no dysplasia edges of the fistula. The chest CT without contrast confirmed the diagnosis of a foreign body that was embedded in the thoracic esophagus. To remove the denture and repair the esophageal-bronchial fistula with the interposition of a flap of intercostal muscle, our patient had received a right thoracotomy. At the bronchoscopy check up, the postoperative recovery was marked by a persistent fistula (Figure 1). He had been taken to a bi-esophageal exclusion with a restoration of digestive continuity with esophageal coloplasty in Retrosternal after a period of resuscitation and recharge gastrostomy. The operating result in the short term was simple. A cervical high solid food dysphagia was noted after one month of intervention and the patient had received a session of expansion by candle as well as a progressive disappearance of the symptoms after a six-month decline.

Citation: Razafimanjato Narindra NM, Rakotoarisoa AJ, Ramanampamonjy RM and Rakotovao HJ. Oeso- Tracheal Fistula on a Forgotten Denture: Diagnosis and Management through an Unusual Clinical Case. Austin J Clin Case Rep. 2016; 3(5): 1107. ISSN:2381-912X