Unrecognized tracheo-oesophageal fistula.

A patient with a retropharyngeal carcinoma was anaesthetized for laryngoscopy, oesophagoscopy and biopsy. Suggestive symptoms of a tracheo-oesophageal fistula were absent and a barium swallow did not demonstrate its presence. Sign of an abnormal communication appeared for the first time after the patient had been intubated and positive airway pressure applied. Measures which might be taken to overcome this problem are suggested.