ADULT CASE OF CONGENITAL ESOPHAGOBRONCHIAL FISTULA OF BRAIMBRIDGE TYPE I COMPLICATED WITH A BRAIN ABSCESS

Abstract

A case of adult esophagobronchial fistula in a 53-year-old man who had been suffering from multiple brain absess is reported on. The patient was found to have an abnormal shadow in a chest X-ray film during the treatment of the brain absess. Until then, he had frequent episodes of coughing after drinking water. Upper gastrointestinal X-ray and endoscopic examination revealed an esophagobronchial fistula. The fistula and the S6 of the right lung were resected. Pathological examination showed that the wall of fistula was covered with two types of epithelium which were squamous cell and columner cell. And a transitional image of these two epithelia was recognized. Because of this pathological and clinical findings it was diagnosed with congenital esophagobronchial fistula (Braimbridge's type I). Adult esophagobronchial fistula is a rare disease and only 104 cases including the present case have been reported in Japan unitl 1992. According to Braimbridge's classification for congenital esophageal fistula in adults who proposed 4 types, these 104 cases can be classfied into type I for 42 cases; type II for 46cases; type III for 13 cases; type IV for 3 cases; and unclassified for one case. The opening sites of the fistule are frequently seen in the B6 of the right lung and the right lower lobe. In the definite diagnosis of this disease pathological finding of the fistula wall plays an important role. In tem of karasawa's proposal that the diagnosis is made for the case which has three components of both tracheal and esophageal mucosa and muscle layer or has a shift pattern of both tracheal and esophageal mucosa, only 44 (including this case) out of 104 cases can be considered those of this disease. The remaining 60 cases might have be reevaluated.