Bronchoesophageal Fistula Research Articles

Tracheal agenesis and esophageal atresia with proximal and distal bronchoesophageal fistulas

Tracheal agenesis (TA) is an extremely rare, typically fatal congenital tracheal malformation. Lack of prenatal symptoms and emergent presentation usually lead to a failure to arrive at the correct diagnosis and manage the airway properly before the onset of irreversible cerebral anoxia. Esophageal atresia (EA) encompasses a group of congenital anomalies comprising an interruption of the continuity of the esophagus with or without a persistent communication with the trachea. In 86% of cases, there is a distal tracheoesophageal fistula (TEF); in 7%, there is no fistulous connection, whereas in 4%, there is a TEF without atresia. We report the case of an infant born with TA and EA with proximal and distal bronchoesophageal fistulas. During 3 consecutive antenatal ultrasound examinations, there had been polyhydramniosis, difficulty visualizing the stomach, and dilatation of proximal esophagus, leading to a presumptive diagnosis of EA. The clinical presentation, embryology, classification, and surgical management are discussed.

Congenital bronchoesophageal fistula in an elderly lady

We present a case report of a congenital bronchoesophageal fistula presenting late in life. Bronchoesophageal fistulae commonly present in neonates, but sometimes, as in the present case they may be clinically silent till old age. She had a relatively short symptomatic period of around eighteen months. She was diagnosed on the basis of contrast computed tomography (CT), bronchoscopy and esophagoscopy, and underwent resection.

Bronchoesophageal fistula in a patient with non-Hodgkin’s lymphoma

Bronchoesophageal fistula secondary to lymphoma is a very rare condition, usually associated with chemo-radiotherapy. We report a case of a patient with a non-Hodgkin's lymphoma (NHL) who, after chemotherapy, developed an oesophago-tracheal fistula. Initially it was treated conservatively but due to the lack of response, a stent was inserted. After nearly one year without success, surgery was considered. Right thoracotomy oesophagectomy and closure of the tracheal defect with an intercostal muscle flap and pericardial patch was performed. This was followed by laparoscopic creation of a gastric tube, which was successfully anastomosed to the cervical oesophagus through a cervicotomy. Unlike oesophageal cancer, NHL can have a good prognosis, so curative treatment of the fistula can be considered. Conservative treatment must always be the first option, leaving stenting or surgery for when the problem persists.

Treatment of Anastomotic Leakage and Benign Esophageal Perforation By Esophageal Or Colorectal Self-Expandable Metal Stents (SEMS)

Background: The intrathoracic anastomotic leakage and the benign esophageal perforation carry a high morbidity and mortality. Methods: Nine patients (6 males, 3 females), mean age 58.5 years (range: 43–70) were treated for bronchoesophageal fistulas following esophagogastrostomy (3), anastomotic leaks after total gastrectomy (2), Boerhaave's syndrome (2), perforation after oesohageal dilation (1) and after a foreign body ingestion (1) by esophageal or colorectal SEMS (eSEMS or cSEMS) placement. The mean defect diameter was 2 cm.

Palliative endoscopic therapy for cancer patients with esophageal fistula

ObjectiveTo find an effective treatment for advanced cancer patients with esophageal fistula.MethodsFrom 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carcinomatous esophageal fistula (3 females, 44 males, aged 29–92 years). Ten patients with both esophageal cancer stricture and fistula were first dilated under endoscope, then a memory stent with a membrane was placed in the esophageal lumen. Others were treated only with a memory stent with a membrane, three of them with a large fistula (diameter >1.5 cm) were treated with bio-protein glue after placement of an esophageal metal stent.ResultsThe fistulas were covered by a stent and the patients could eat and drink immediately. Their quality of life was improved and their survival was prolonged, 44 out of 47 patients survived for >3 mo.ConclusionPlacement of esophageal stent with membrane or in combination with bio-protein glue through endoscope is an effective method for treating the bronchoesophageal fistula.

A Case of Bronchoesophageal Fistula Mimicking Pulmonary Tuberculosis

Benign bronchoesophageal fistula is a rare disease and it may be characterized by nonspecific symptoms that can cause a delayed diagnosis. We misdiagnosed a patient with recurrent aspiration, which was due to bronchoesophageal fistula, as active pulmonary tuberculosis. The patient was 44 year old female who had suffered from chronic cough, especially during eating liquid meals, since 1982 when she had been treated for tuberculous lymphadenitis. Computed tomography showed an irregular mass with surrounding centrilobular nodules in the superior segment of the right lower lobe (RLL). She was diagnosed as having active pulmonary tuberculosis and treated with anti-tuberculosis medication, but she continued to complain of persistent cough even after anti-tuberculosis treatment. Thus, we reexamined the patient, and bronchoesophageal fistula between the esophagus and the superior segment of the RLL was finally confirmed by esophagography. After the fistula was surgically treated, the patient became asymptomatic and she then experienced good health.

P-083 Bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia(Poster Session Esophagus, stomach 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-083 Bronchoesophageal fistula and tracheoesophageal fistula with esophageal atresia(Poster Session Esophagus, stomach 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Various Bronchial Fistulas: Pitfalls and Usefulness on CT. A Pictorial Review

The presence and type of bronchial fistulas connected with various organs within the thorax were examined. The types of bronchial fistulas include bronchopleural, bronchoesophageal, adenobronchial, bronchomediastinal, bronchovascular, and other variants. The bronchopleural fistula included a central bronchopleural and peripheral bronchopleural fistula, as well as a bronchoesophageal fistula consisting of congenital and acquired fistula. Generally, an adenobronchial fistula generated by pulmonary tuberculosis or corrosive esophagitis. These conditions may have originated from bronchomediastinal and bronchovascula fistula. The computed tomography results revealed the connection of the bronchial fistula with organs and causative diseases. In addition, applying multiplanar reformatted images provided a the accurate location of bronchial fistula. In this type of clinical atlas, the type of bronchial fistulas and their imagings were introduced.

Endoscopic Management for Broncholithiasis With Bronchoesophageal Fistula

We report a case of broncholithiasis with bronchoesophageal fistula that was successfully managed endoscopically using endoscopic laser therapy and a covered self-expandable metallic stent.

Successful tubes treatment of esophageal fistula

To discuss the merits of "tubes treatment" for esophageal fistula (EF). A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

Adult Congenital Bronchoesophageal Fistula

Congenital bronchoesophageal fistula is a rare anomaly that requires surgical repair. A case of an incidental type II congenital bronchoesophageal fistula in a 58-year-old woman is reported. Barium swallow, esophagoduodenoscopy, bronchoscopy, and computed tomography of the chest demonstrated a bronchoesophageal fistula. Thoracotomy and resection of the fistula with reinforcement of the esophageal staple line achieved healing without postoperative complications.

Long-term results of surgical treatment in benign bronchoesophageal fistula

Benign bronchoesophageal fistula is a rare complication resulting from various diseases. The objectives of the study are to report our surgical experience in patients with benign bronchoesophageal fistulas and to evaluate the long-term results of surgical management. Between 1995 and 2005, a total of 14 patients (mean age, 52.5 years; male/female = 6:8) underwent operations for benign bronchoesophageal fistulas. The etiology of the fistulas included traction esophageal diverticula in 7 patients and tuberculous lymphadenopathy in 6. Primary repair of the fistula was performed in all patients and a concomitant lobectomy in 6. There was no in-hospital mortality. Postoperative complications occurred in 1 patient (empyema resulting from a leakage at the repair site). Postoperative esophagography revealed a leakage at the repair site in 1 patient. There was 1 late death with a mean follow-up of 43.9 months. The cause of death was aspiration pneumonia resulting from recurrent fistula. Two of 8 patients who did not undergo a lobectomy had persistent bronchiectasis, whereas none of those who underwent a concomitant lobectomy had any recurrent pneumonia or bronchiectasis. The overall survival was 100% at 5 years and the mean survival time was 124 months (95% confidence interval, 106.5-142.2 months). We conclude from these data that early detection and definitive surgical repair of benign bronchoesophageal fistulas can yield high success rates with excellent early outcomes and good long-term results.

Management of congenital tracheal agenesis

Heimann et al. [2] reported three patients with agenesis of the trachea. Although a very rare disease, tracheal agenesis is of eminent importance for neonatologists when they are confronted in the delivery room with a hypoxic neonate and the inability to perform endotracheal intubation. So they are challenged not only to achieve adequate oxygenation but also to quickly confirm whether the patient has a lethal or potentially curable malformation of the respiratory system. Extending the data of Heimann et al. we report two additional patients with tracheal agenesis. Both presented postnatally with cyanosis and the absence of audible cry. Although endotracheal intubation failed, adequate oxygenation was achieved via transoesophageal ventilation since a broncho-oesophageal fistula was patent in our patients as well as in almost all of those previously described. Ventilation through a tube, inserted orally into the oesophagus, might be the only option to gain time for further investigations. The diagnostic tool of choice is laryngobronchoscopy combined with a computed tomography (CT) scan or magnetic resonance imaging. Rapid diagnosis is vital to differentiate between a high obstructive airway syndrome (HOAS) like laryngeal atresia, in which tracheotomy would be life-saving, and tracheal agenesis, where potential surgical options depend on the extent of atresia present [3]. As in our first patient laryngobronchoscopy or CT scan were not available in the delivering hospital, explorative surgery with incision of the upper thoracic aperture was performed under transoesophageal ventilation and tracheal agenesis was confirmed. Transoesophageal ventilation achieved oxygenation; however, hyperinflation of the stomach occurred because of an imperforate anus. Gastrostomy was performed to decompress the gastrointestinal tract. A Fogarty catheter was inserted into the stomach, placed into the distal part of the oesophagus with the intention to block the distal oesophagus; but after incision, the opened stomach presented as a major ‘air leak’ and oxygenation failed. Resuscitation was terminated 4 h after birth. Autopsy revealed Floyd type II tracheal atresia and anal atresia. In our second patient, total tracheal agenesis was confirmed by bronchoscopy and CT. After 48 h of uneventful transoesophageal ventilation with sufficient oxygenation, ventilation was discontinued because parental consent for further surgery (banding of the lower oesophagus, insertion of gastrotube as first step) could not be obtained. The patient died 49 h after birth. Most reported newborns with tracheal agenesis expire postnatally and long-term survival is rare [1]. However, if tracheal agenesis is considered during resuscitation, intubation of the oesophagus and ventilation via a bronchooesophageal fistula is an option to manage these patients until an exact diagnosis can be made. Our experience emphasizes the importance of an early and rapid discrimination between tracheal agenesis and HOAS.

Coexistence of a Tuberculous Bronchoesophageal Fistula and Intracranial Tuberculosis in an Immunocompetent Patient

Coexistence of a Tuberculous Bronchoesophageal Fistula and Intracranial Tuberculosis in an Immunocompetent Patient

The Tuberculous Bronchoesophageal Fistula Detected during Induction of General Anesthesia in Brain Abscess Patient -A case report -

We report a case of bronchoesophageal fistula detected during induction of general anesthesia in brain abscess patient. Bubbling sound at substernal area and gas bubble at oral cavity during manually assisted mask ventilation, especially inspiration, were detected. Barium esophagography, gastroscopy and bronchoscophy were performed to know the nature of fistula after neurosurgical operation. The patient had a bronchoesophageal fistula due to unproperly treated old pulmonary tuberculosis. Esophageal opening of fistula located at midesophagus about 27 cm distance from incisor, while bronchial opening located at apical segment of right superior bronchus. It depends on the size, location, and duration of fistula to manifest clinical symptom. In bronchoesophageal fistula, the size of opening tends to be small and gradual symptom onset while relatively large and early in TEF. Therefore, knowledge of the differences of two types of fistula are essential to manage the patient who have these types of fistula.

Congenital bronchoesophageal fistula in an adult: A case report

Bronchoesophageal fistulas are usually diagnosed in the neonatal period. As such, the condition is rare in adults. We present a case of a congenital bronchoesophageal fistula in a 62-year-old man with the complaint of severe bouts of cough and choking after swallowing liquid. His workup included a barium esophagogram that revealed a fistula between the esophagus and a right lower lobe bronchus. The diagnosis should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology. The fistula was divided and resected, The patient had an uneventful recovery.

Esophageal stent improves ventilation in a child with a broncho‐esophageal fistula caused by Mycobacterium tuberculosis

The deployment of an esophageal stent to aid in the ventilation of a child who had developed an acquired broncho-esophageal fistula caused by Mycobacterium tuberculosis (MTB) is described. The 12-month-old boy presented with respiratory failure requiring ventilation. The air leak via the fistula led to inadequate mechanical ventilation. The deployment of the stent resulted in successful ventilation, closure of the fistula, and eventual successful treatment.

Benign broncho-esophageal fistula in adult- Two case reports

Broncho-esophageal fistula (BEF) in adult is commonly due to malignancy. Benign BEF is rare. The common causes are mediastinal inflamation, due to tuberculosis, histoplasmosis, etc. This, can present with chronic cough, asthma or pulmonary sepsis. The symptoms are not as pronounced as in tracheo-esophageal fistula. Barium swallow helps to confirm the diagnosis. Esophagoscopy and bronchoscopy are routine to exclude any associated pathologies and also to evaluate the distal esophagus for any obstruction. Excision of the tract with closure of both ends and soft tissue interposition is curative. In both the cases there was no evidence of mediastinal inflamation like periesophageal adhesions or fibrosis or lymphadenopathy. Both the patients were treated surgically with good results.

Gastrointestinal: Tuberculous bronchoesophageal fistula

What abnormalities are shown on the barium swallow radiograph shown in Figure 1? One obvious abnormality is the presence of barium in the trachea and right main bronchus. In addition, there is a fistula between the lower lobe bronchus and the midportion of the esophagus (arrow). There are no obvious radiological features of cancer of the esophagus or lung. At esophagoscopy, the esophagus was deformed in the region of the fistula and biopsies from the mucosa around the esophageal orifice revealed chronic inflammation with granulomas and Langerhan’s giant cells (H&E ×10; Fig. 2). The diagnosis was that of a bronchoesophageal fistula caused by tuberculosis. The patient was a 20-year-old woman who was investigated because of a non-productive cough and low-grade fever for 2 months, with the subsequent development of paroxysms of coughing after drinking fluids. She was treated with nasogastric feeding and antituberculous drugs, and the fistula closed after 6 weeks. A communication between the esophagus and the tracheobronchial system is an unusual clinical disorder that can be either congenital or acquired. Congenital fistulas are usually diagnosed in the neonatal period because of respiratory distress and cyanosis during feeding. However, rare examples of congenital fistulas have been described in adults who are investigated because of recurrent pneumonia or bronchiectasis. The most common cause of acquired fistulas is an advanced cancer that arises from the esophagus or lung. Most of these fistulas involve a communication between the upper esophagus and the trachea. Non-malignant causes of fistulas are rare but include infections such as tuberculosis and syphilis, mediastinal abscesses, chest trauma and complications of prolonged intubation. Possible mechanisms for the development of tuberculous fistulas include rupture of caseonecrotic subcarinal lymph nodes into the esophagus and respiratory tract, erosion of primary tracheal ulcers into the esophagus or the development of traction diverticula between the respiratory tree and the esophagus. In contrast to malignant disease, tuberculous fistulas usually involve the right or left main bronchus rather than the trachea. Closure of tuberculous fistulas can usually be achieved with conservative measures as described above. However, surgical repair may be required for large fistulas complicated by recurrent pneumonia.

Congenital broncho-esophageal fistula: A case report

Bronchopulmonary foregut malformations are a group of rare congenital anomalies affecting the respiratory and upper gastrointestinal tract. The rarity of these cases means their embryological origin continues to be a source of controversy. We present the case of a female infant, born at term with a malformed right arm, an absent right kidney and aplasia of the right lung. Although initially asymptomatic she presented at 5 months of age in severe respiratory distress. An upper gastro-intestinal contrast study demonstrated a right broncho-esophageal fistula. At surgical resection it was discovered that the right main bronchus ended abruptly just beyond the carina, with total aplasia of the right lung. A bronchoesophageal fistula originating from the lower third of the esophagus communicated with a sequestered right lobe. The lobe was removed and the fistula ligated. The infant remains well 13 months post surgery. This represents only the twelfth case of this rare form of bronchopulmonary foregut malformation. The associated renal and limb malformations make this case unique and may add weight to the theory that the underlying insult to the developing lung is vascular in origin.