LAUSR

Adult tracheoesophageal fistula (TOF) is a rare pathology secondary to malignancy, trauma, pressurenecrosis (endotracheal/tracheostomy tube cuff), infection or iatrogenesis.[1,2] Carcinoma oesophagus is the most common malignancy with 4.7% developing TOF.[3] Management includes oesophageal/tracheal/ dual stenting and retrosternal bypass, whereas over-the-scope clipping systems, tissue matrices, endoscopic fibrin-glue and atrial septal closure devices are currently experimental.[4] We describe here a case of a 59-year-old, 40 kg, post-radiotherapy, post-chemotherapy male patient in whom after failed stenting attempts, palliative retrosternal oesophageal-bypass surgery with gastric-conduit reconstruction for metastatic carcinoma oesophagus was successfully performed. The inherent anaesthetic challenges included TOF-isolation to prevent regurgitation and avoiding gas-leak during ventilation.