A challenging Paediatric Airway Management; Acquired Tracheo-oesophageal Fistula Following Accidental Ingestion of a Metal Bobbin

Acquired trachea-esophageal fistula formation is a rare, life-threatening complication of delayed presentation of foreign body ingestion. Airway management of such a patient is a significant challenge to the anaesthetist due to air leak from the defect leading to difficult oxygenation and ventilation and gastric insufflation. The paediatric age group adds to the difficulty because of small airway caliber and difficult lung isolation.
Multidisciplinary team involvement and close communication, prior imaging to identify the anatomy, and planning were vital for successful outcome.