A case report of medically managed esophageal fistula due to complicated esophageal tuberculosis

Abstract

Introduction and importanceEsophageal TB is a relatively uncommon condition. Mostly, the esophagus can be affected by tuberculosis through direct spread or from mediastinal nodes (rarely from the lungs or bloodstream). The most common symptom is dysphagia, and the diagnosis is confirmed by histology. If left untreated, esophageal tuberculosis can result in bleeding, perforation, fistula formation, aspiration pneumonia, lethal hematemesis, traction diverticula, and esophageal strictures.Case presentationThis is a rare case report of an esophageal fistula caused by tuberculosis in a patient presenting with a cough on eating and weight loss. The patient was subjected to upper gastrointestinal endoscopy, which revealed a cervical esophagus fistula 20 cm from the upper central incisors. Histopathology revealed inflammatory lesions with epithelioid granulomas (granulomatous disease). A mycobacterium sputum examination was performed; the smear was negative. The patient was managed conservatively with anti-tuberculosis treatment (ATT). A follow-up endoscopy after two months revealed that the fistula was closed and clinically improved.Clinical discussionThe quick clearance of contaminated sputum by coordinated peristalsis, paired with upright posture and an intact lower esophageal sphincter, limits the organism's exposure to the esophagus.ConclusionDespite the disease's rarity, if not delayed, it can be efficiently managed with ATT to avoid major complications like esophageal perforation, which necessitates surgery.