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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Future Management For Tracheoesophageal Fistula

My father of 78-year of age has a Stage IV esophagous cancer for over 20 months. He has completed 35 Chemos and 15 rounds of radiation. He suffered fever on the last day of his radiation 10 days ago and the medical team has determined that the infection that caused his fever was due to pneumonia resulting from Tracheoesophagel Fistula. The pulmonary specialist, and the surgeon do not recommend surgery due to cancer and both doctors think my father has short time left to live (about 1 to 2 months). However, the oncologist thinks that there is a possibility that with time, though very slowly, tracheoesophagel fistula may heal itself with the ongoing antibiotics treatment given the pnumonia my father is suffering is not sever. What are your thoughts on differences of opinions among the doctors and what is the best care for my father going forward (LTAC or Home Health Care)? Thank you in advance for your help.
posted on Mon, 2 Jun 2014
Twitter Wed, 18 Mar 2015 Answered on
Twitter Wed, 18 Mar 2015 Last reviewed on
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Radiologist,  's  Response
Hi,
Thanks for writing in.

Sorry to hear about the progress of disease in your father and the development of tracheoesophageal fistula. In this condition, there is a communication between the airway and food pipe and the patient can aspirate food contents in to the lungs causing a severe infection.

As early as 10 days after radiation, the area might still be raw and surgery is not a good option. This can complicate the situation and worsen the disease. If the fistula is small then with time, the area around the tracheoesophageal fistula can heal and form fibrosis. This is a healed scar tissue ad can help in spontaneous closure of the fistula.

Also the pneumonia is not severe and antibiotics are being given to take care of the infection. At this point in time, your father must be made comfortable and his pain reduced as much possible. The first step remains curing him of the pneumonia and extend his survival by a few months. I understand that he is taking ryles tube feeding. Then next we have to provide him adequate pain relief and that can mean increasing his medications to make him feel comfortable. This can be followed by waiting for the tracheoesophageal fistula to heal.

If the initial part of pneumonia can be taken care of in a hospital then he can be provided home health care after he is stable.
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Suggest Future Management For Tracheoesophageal Fistula

Hi, Thanks for writing in. Sorry to hear about the progress of disease in your father and the development of tracheoesophageal fistula. In this condition, there is a communication between the airway and food pipe and the patient can aspirate food contents in to the lungs causing a severe infection. As early as 10 days after radiation, the area might still be raw and surgery is not a good option. This can complicate the situation and worsen the disease. If the fistula is small then with time, the area around the tracheoesophageal fistula can heal and form fibrosis. This is a healed scar tissue ad can help in spontaneous closure of the fistula. Also the pneumonia is not severe and antibiotics are being given to take care of the infection. At this point in time, your father must be made comfortable and his pain reduced as much possible. The first step remains curing him of the pneumonia and extend his survival by a few months. I understand that he is taking ryles tube feeding. Then next we have to provide him adequate pain relief and that can mean increasing his medications to make him feel comfortable. This can be followed by waiting for the tracheoesophageal fistula to heal. If the initial part of pneumonia can be taken care of in a hospital then he can be provided home health care after he is stable.