Abstract
BackgroundAcquired benign bronchoesophageal fistula (BEF) is rare and develops as a complication of other diseases, mostly of inflammatory processes and traumas of the chest. The treatment of choice is a surgical repair, which is considered definitive and leads to successful outcomes. However, incidence of recurrence after the primary repair based on limited data is up to 10% and its treatment is challenging. We report a surgical case of a patient with recurrent acquired benign BEF after primary resection and ensuing successful definitive repair with esophageal bypass surgery after temporary esophageal stenting.Case reportA 46-year-old male was referred to our department with a symptomatic left-sided bronchoesophageal fistula as a complication of severe acute necrotizing mediastinitis that originated from odontogenic abscess. Previously, several cervicotomies and bilateral thoracotomy were performed at an external medical facility to manage the acute condition. We performed resection of the fistula through re-thoracotomy. Postprocedural esophagography demonstrated a recurrence of bronchoesophageal communication. Postinflammatory adhesions excluded further repair through thoracotomy, therefore a stent was introduced in the esophagus for 12 weeks. Thereafter, an esophageal bypass surgery using a substernaly interposed gastric conduit was performed and resulted in an excellent long-term outcome.ConclusionsEsophageal bypass surgery using a substernaly interposed gastric conduit may be considered if the standard surgical repair of acquired benign bronchoesophageal fistula is not successful or feasible.
Highlights
ConclusionsEsophageal bypass surgery using a substernaly interposed gastric conduit may be considered if the standard surgical repair of acquired benign bronchoesophageal fistula is not successful or feasible
Acquired benign bronchoesophageal fistula (BEF) is a rare pathology, which develops as a complication of other diseases, mostly of inflammatory processes and traumas of the chest
Several reports of primary endoscopic treatment of BEF were published, first-line treatment remains surgical repair which results in excellent long-term outcomes and should be performed as soon as possible after diagnosis [3, 4]
Summary
Esophageal bypass surgery may be considered if the standard surgical repair of acquired benign BEF is not successful or feasible. In addition to surgical treatment, the case demonstrates an essential significance of the interdisciplinary approach and use of other supportive
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