Congenital Bronchoesophageal Fistula Research Articles

Repair of a three-way congenital bronchoesophageal fistula in an adult patient: a case report

BackgroundThe incidence of congenital bronchoesophageal fistulas in adults is rare. Most fistulas discovered in adulthood are often small and can be repaired with a simple one-step method.Case presentationA 46-year-old female patient complained of a 2-month history of chocking, coughing, and a 12 kg drop in weight. The bronchofiberscopy and gastroscopy showed a large fistula, which extended from the esophagus to the main bronchus on both sides, thus forming a special three-way channel which has never been reported. This case was challenging both to the anesthetists and surgeons. The patient was intubated with a sengstaken-blakemore tube, and then received segmental esophageal resection, anastomotic reconstruction, and double-flap repair with esophagus segment in situ.ConclusionWhen the fistula in BEF is large or complicated, appropriate surgical methods should be meticulously designed according to the condition of the patient. The problem of anesthesia intubation should be solved first, to allow a smooth operation. Secondly, a double-layer repair of the airway fistula by using esophageal wall tissues as patch materials is proposed.

Adult Benign, Non-Iatrogenic Bronchoesophageal Fistulae: Systematic Review and Descriptive Analysis of Individual Patient Data.

Adult, benign, non-iatrogenic bronchoesophageal fistula (BEF) is a rare condition, which is occasionally described in single case reports. Therefore, little is known about its possible causes, presentation and management. A systematic search of the literature in MEDLINE, PubMed Central and EMBASE databases between 1990 and 2020 was carried out to identify all cases of BEF. The initial database search identified 19,452 articles, of which 183 (251 individual patient cases) were included in the final analysis. Main causes of BEF were congenital malformations (97/251, 38.7%) and infections (82/251, 32.7%), while 33/251 (13.1%) fistulae were regarded as idiopathic and 39/251 (15.5%) attributed to other causes. Esophagograpy was the most sensitive method of diagnosis (97.4%) compared with esophagoscopy (78.9%), computed tomography (49.6%) and bronchoscopy (46.0%). Definitive treatment was surgical for 176 patients (70%), endoscopic for 25 (10%) and medical for 37 (14.7%). Compared with congenital BEFs, infective BEFs had shorter median symptom duration and were distributed more proximally over the bronchial tree. Definitive treatment was almost only surgical for congenital BEFs, while infective BEFs were treated also endoscopically (12%) and by medical therapy (38%). Morbidity, treatment failure and recurrence rates were higher for infective BEFs. BEFs are rare. Symptoms are non-specific and a high index of suspicion is necessary for diagnosis. Patients with infective BEF tend to have a more severe clinical picture than those with congenital BEF. Surgery is the main treatment for patients affected by congenital BEF, while infective BEFs may heal conservatively.

Isolated Congenital Bronchoesophageal Fistula in a Pediatric Patient: Case Report

Abstract Introduction/Objective Congenital bronchoesophageal fistula (BEF) results from an undue passageway caudal to the foregut lung anlage. BEF may be associated with esophageal atresia and commonly involves the right lung. Herein we present a pediatric case of isolated congenital BEF masqueraded by severe dyspeptic symptoms. Methods A five-year-old child with a longstanding history of gastroesophageal reflux was hospitalized because of acute onset sharp lower chest/epigastric abdominal pain associated with emesis. Imaging disclosed a left lung abscess and empyema that responded to intravenous antibiotics, chest tPA instillation and drainage. After resolution of her empyema, she experienced severe dysphagia, chocking sensation, vomiting, and intermittent hematemesis. Esophogram disclosed a fistulous tract to the left lower chest cavity. Esophagoscopy revealed severe esophagitis and a stricture just proximal to a 0.6 to 0.8 cm ostium of a fistulous tract at 26 cm from the incisors, 2 cm above the gastroesophageal junction. Results A 103 g, 12 x 7.5 x 5.0 cm thoracoscopic left lower lobectomy showed a focally ulcerated fistulous tract that entered a 1.9 cm in diameter cyst that connected to a basilar-medial segmental bronchus. The passage was lined by stratified squamous epithelium, continuous with columnar ciliated epithelium, and was surrounded by intense chronic inflammation. The fistulous lumen contained partially degraded vegetable matter. Diagnosing BEF can be clinically challenging. Symptoms are often intermittent, alternating between digestive and pulmonary in nature. Often, cough, gastroesophageal reflux, pneumonia, and bronchopulmonary suppuration can lead to medical management that is only masking, not definitively treating the underlying pathology. While tracheoesophageal fistulas are relatively common in presentation, and usually diagnosed in the newborn period, BEFs are rare and with varied clinical expression, which may explain delayed diagnosis. Conclusion BEF is a rare anomaly that may manifest ambiguous symptoms, thus delaying the diagnosis and options for earlier, less invasive curative interventions.

Recurrent Aspiration Pneumonia in a Missed Case of Broncho-Esophageal Fistula with Repaired Esophageal Atresia: Usefulness of Fiberoptic Bronchoscopy: A Case Report

: Broncho-esophageal fistula (BEF) is a rare congenital anomaly affecting the respiratory and upper gastrointestinal tract. The rarity makes its timely diagnosis very challenging. This study presents a rare case of missed congenital BEF in a six-year-old girl with repaired esophageal atresia in the neonatal period suffering from recurrent respiratory symptoms, choking, and respiratory distress following eating, resulting in vomiting or regurgitation for three years before admission. While the contrast esophagography and endoscopy had failed to diagnose her problem, the methylene blue test via an esophageal catheter observed by fiberoptic bronchoscopy could detect the presence of BEF reliably in the present case. Presenting this case can raise physicians’ knowledge of the diagnostic role of methylene blue test via fiberoptic bronchoscopy.

Congenital bronchoesophageal fistula in an adult: a case report and radiologic review

Congenital bronchoesophageal fistula (BEF) is rarely reported in adults in the English literature. Herein, we present a rare case of congenital BEF in a 43-year-old man that was incidentally found on esophagogastroduodenoscopy. Chest CT and barium esophagography revealed a fistula between his lower esophagus and the right lower lobe segmental bronchus. After the fistula was surgically treated, the fistula was no longer noted on follow-up barium esophagography.

食道憩室を有する成人型先天性気管支食道瘻の 1 手術例

食道憩室を有する成人型先天性気管支食道瘻の 1 手術例

Congenital broncho-esophageal fistula presenting as persistent lung abscess

We describe an 8-year-old male who presented with persistent lung abscess. The boy was subsequently found to be having congenital broncho-esophageal fistula. This condition has been reported rarely worldwide in children. It is probably the first case of congenital broncho-esophageal fistula presenting as persistent lung abscess from India.

健側アプローチによる成人の先天性食道気管支瘻の一手術例

健側アプローチによる成人の先天性食道気管支瘻の一手術例

Congenital Bronchoesophageal Fistula Diagnosed in Late Adulthood

Introduction: A 69-year-old man with a history of right thoracotomy with decortication and drainage of empyema 34 years ago, presented with a 25-year history of dysphagia and coughing up of food and liquids and recurrent respiratory infections. EGD 8 years ago showed possible achalasia and mid-esopha-geal diverticulum. Recent evaluation for pneumonia included barium esophagram showing a fistula from the lower esophagus to the right lower lobe bronchi. CT showed right lower lobe bronchiectasis, infiltrate and dilated esophagus but did not visualize a fistula. EGD revealed a 3mm fistula in the middle third of the esophagus and no other lesions in the esophagus. Bronchoscopy showed no endobronchial lesions but could not initially identify the fistula site. EGD was performed simultaneously with bronchoscopy and saline with methylene blue was injected through the esophageal side of the fistula using an ERCP cannula. Bronchoscopy revealed passage of air bubbles and methylene blue through a bronchus [posterior subsegment of the superior basal segment of right lower lobe (B8a)], localizing the exact fistula site. He had surgical repair involving division of the fistula tract with intercostal muscle-flap interposition. There was no persistent fistula on EGD and esophagram. Congenital bronchoesophageal fistula (BEF) is rare in adults but can be unrecognized for years, with symptom duration varying from 5-50 years before diagnosis. Age at diagnosis ranges from 9-83 years. Symptoms include cough, frequent respiratory infections, hemoptysis and bouts of cough when swallowing liquids (Ohno’s sign). Barium esophagram is the most sensitive test compared to endoscopy and bronchoscopy. Complications include recurrent pneumonia, abscess and bronchiectasis. Definitive treatment involves surgical closure of the fistula tract, with interposition of viable tissue such as intercostal muscle to prevent refistulization. The insidious course of congenital BEF, the absence of surrounding inflammation and adherent lymph nodes, and our patient’s history support a congenital nature of the fistula. In summary, we illustrated a case of congenital bronchoesophageal fistula diagnosed in late adulthood by barium esophagram, confirmed by simultaneous EGD and bronchoscopy and managed by surgical repair.Figure 1: (A) EGD of esophageal side of fistula. (B) Bronchoscopy showing methylene blue leaked through bronchial side of fistula when methylene blue was instilled into the fistula during EGD.

Congenital Bronchoesophageal Fistula with Imperforate Anus and Atrial Septal Defect in a 3-Year-Old Child

Congenital bronchoesophageal fistula (BEF), congenital communication between esophagus and bronchus, is a rare malformation. Benign BEF shows only nonspecific symptoms that may delay a correct diagnosis and proper treatment. This is a case of a 3-year-old boy presenting congenital BEF with imperforate anus and atrial septal defect. He had recurrent pneumonia in the right lower lobe since he was 5 months old. A barium swallow examination showed a communicating fistula between the lower esophagus and the right lower lobe bronchus. Computed tomography scan supported to delineate the course of the fistula. He underwent resection surgery of the fistula and lobectomy of the right lower lobe. He recovered without any postoperative complications. [Pediatr Allergy Respir Dis(Korea) 2012;22:428-432]

Anesthetic management of congenital broncho-esophageal fistula in an adult

Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.

Diagnosis of congenital broncho-esophageal fistula in a 62-year-old male

Congenital broncho-esophageal fistula (BEF) may go unrecognized in infancy and childhood and present later in life, due to non specific signs and symptoms. We report an adult case of congenital BEF which was diagnosed after massive aspiration precipitated by raised intra abdominal pressure due to severe acute pancreatitis.

Aspiration Via Congenital Broncho-esophageal Fistula After Lobectomy

Aspiration via a congenital broncho-esophageal fistula in an adult thoracotomy patient has not been previously reported. Repeated aspiration and subsequent respiratory failure if the fistula is not recognized could be life-threatening in these postoperative patients. We describe one such critical case, in which a broncho-esophageal fistula was discovered weeks after aspiration and the onset of respiratory failure after left lower lobectomy. This unusual case suggests that repeated localized pulmonary infections can indicate a broncho-esophageal fistula and that further investigations should be performed, including detailed history.

Recurrent Pneumonia in a 51-Year-Old Woman Due to Congenital Bronchoesophageal Fistula

Recurrent pneumonia in adults can be due to various etiologies. Congenital bronchoesophageal fistula may go undiagnosed in adult patients for many years. In cases of delayed recognition there is a long history of intermittent bouts of cough and choking after swallowing liquid, which may eventually

Congenital bronchoesophageal fistula in adults

To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fistulae in adults. Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively. The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

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.

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.

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.

Congenital Bronchoesophageal Fistula in a Patient With Crohn's Disease: A Cautionary Tale

We present the case of a young lady suffering from Crohn's disease who was diagnosed as having a disabling bronchoesophageal fistula. This was mistakenly thought to be due to the Crohn's disease, and surgery was declined for fear of further complications. She required multiple admissions for frequent chest infections. At review, 5 years later for a second opinion, the fistula was deemed congenital in origin. The fistula was successfully resected, and the histology confirmed the diagnosis.

Double congenital bronchoesophageal fistulae in an adult.

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.