Nonsymptomatic Tracheocele-Like Sac After Tracheoesophageal Fistula Repair

Abstract

A 71-year-old man with a history of benign esophageal stenosis was admitted to our department for dysphagia. Because of the recurrence of stenosis, a selfexpandable esophageal stent (Ultraflex; Boston Scientific, Boston, MA) was placed at the proximal esophagus. Six months later, the patient was admitted to our department again because a tracheoesophageal fistula was observed during an endoscopic control as a result of stent displacement. Fiberoptic bronchoscopy confirmed the presence of the fistula at the level of the proximal stent edge (Fig 1). Surgery was performed and the stent was removed carefully through a longitudinal incision along the esophagus near the distal stent edge. The esophagus was then divided just above and below the fistula opening, and it was applied as a protective patch on the fistula. The distal esophagus was excised, and the alimentary tract was reestablished with a substernal narrow gastric tube with cervical anastomosis. The postoperative course was uneventful, and the patient was discharged after 12 days in good condition. At 1 year after surgery, a small opening at the level of the prior fistula is present on the fiberoptic bronchoscopy control (Fig 2A). The opening leads to a minimal esophageal blind sac as it could be noticed by threedimensional computed tomographic reconstruction imi-