Treatment of chronic esophageal-pleural fistula as a result of spontaneous rupture of the esophagus (Boerhaave’s syndrome) in patient with achalasia cardia using an endoscopic vacuum therapy

Abstract

A patient with achalasia cardia after surgery for spontaneous rupture of the lower third of the esophagus developed failure of surgical suturing and a chronic esophago-pleural fistula. A control computed tomography of the chest with contrasting of the pleural cavity through the drainage revealed a filiform bronchial fistula. After the completion of endoscopic vacuum aspiration therapy, which consisted of four sessions, positive dynamics was noted in the form of the absence of air and fluid inflow through the drainage, as well as a significant decrease in the fistula orifice according to the endoscopic examination. A positive result was confirmed by X-ray, fistulography and computed tomography with contrasting—no contrast agent was received outside the esophagus and into the left bronchus. 5 months after discharge from the hospital, the patient underwent a combined course of endoscopic balloon dilatation with a good effect due to stage 3 achalasia cardia. According to computed tomography, endoscopic and X-ray examinations, there is no recurrence of the fistula.