Tracheal diverticulum as a cause of ventilation failure after intubation: A case report and review of the literature.

Tracheal diverticulum is a rare and easily overlooked complication following tracheoesophageal fistula repair that poses substantial challenges in airway management for anesthesiologists. We present a case of a 4-month-old girl with esophageal stenosis following tracheoesophageal fistula repair who was presented for repeated endoscopic balloon dilation. During the first two inductions of general anesthesia, endotracheal intubation appeared successful but resulted in unexpected ventilation failure. Successful ventilation was finally achieved after multiple attempts at intubation. Fiberoptic bronchoscopy revealed a tracheal diverticulum before the third induction of anesthesia, explaining the persistent ventilation difficulties. The patient was successfully managed with fiberoptic bronchoscopy-guided intubation while maintaining spontaneous respiration, allowing the endotracheal tube to bypass the diverticulum. This case highlights tracheal diverticulum as an uncommon cause of ineffective ventilation following intubation and suggests that fiberoptic bronchoscopy-guided intubation may be a preferable approach.