Surgical Management of Large Tracheoesophageal Fistula in Infants After Button Battery Ingestion

Button battery ingestion in children is associated with severe morbidity and mortality if not treated promptly, due to the coagulation necrosis that ensues. Formation of a tracheoesophageal fistula (TEF), due to tissue necrosis, is an exceedingly rare complication, albeit one that carries high mortality. This article reports on four cases of TEF, their presentation, perioperative management, the surgical treatment employed, and follow-up. The authors discuss the use of esophagectomy with cervical fistula, repair of the trachea with aortic homograft, and the use of latissimus dorsi pedicled interposition flaps to cover and reinforce large tracheobronchial defects. The authors also discuss their technique and rationale for using aortic homograft due to its stiffer mechanical properties compared to bovine or autologous pericardium, thus, theoretically, applying less stress to suture lines.