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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Need diagnostic explanation of symptoms

Hello , This is Dilip Raval , Diagnosis : CA UPPER OESOPHAGUS WITH TDF , Pre Medication : (a) Calmpose 1 amp (b) Atropine 1 amp (c) Fortwin 1 amp (d) Buscopan 1 amp ,, Findings :- Oesophagus : Ulcer starting from post cricoid region with fistula seen from 22 cm. T.Stomy tube seen in oesophagus. No Frank growth seen. Rest Normal. Stomach : Normal Duodenum : Normal Impression : TOF ,, Biopsy : No ,, Cytology : No ,, Photography : No respested sir , i want your advise for further process , what should i do next ?
Sat, 14 Jun 2014
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General Surgeon 's  Response
HI.
Thanks for your query.
This patient has been on tracheostomy - a tube kept in the trachea for a proper respiration. ( indication not noted by you).
It looks the tube has eroded through the posterior ( back) of the trachea and entered into the esophagus.
This is caled TOF= Tracheo-oesophageal Fistula. This means there is a connection between the trachea ( windpipe ) and oesophagus ( food pipe).
Further process definitely is surgical correction . The fistulous tract is excised and both the tubes are repaired to keep them separate as they were.
Being the most difficult area and a typical blood supply as well as the typical functions , the surgery can be done at a super-specialist center by an exprienced surgeon or a TEAM of surgeons.
The patient's fitness is very important for the outcome of such procedure. The hemoglobin, proteins in the body have to be really optimum and needs a great preparation.
With the advent of stents these procedures have been giving better results.
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