Congenital esophagobronchial fistula treated with thoracoscopic assisted surgery

A case of congenital esophagobronchial fistula in a 58-year-old woman was described. The patient had presented with repeated attacks of pulmonary infection from her childhood and had a history of recurrent cough after eating or drinking. Preoperative examinations including esophagogram by barium swallow revealed existence of a fistula between the upper thoracic esophagus and the right B3 bronchus. The fistula was recognized as type I of Braimbridge classification. Thoracoscopic assisted fistulectomy and diverticulectomy for esophagobronchial fistula with esophageal diverticulum were performed. The neck of the diverticulum and the fistula were divided with endo-stapling technique. Intraoperative esophagoscopy was found to be useful for the definite localization and complete excision of the fistula and the diverticulum and the avoidance of stenosis of the esophagus. Postoperative course was uneventful. It is to be considered that the present thoracoscopic assisted procedure with intraoperative esophagoscopy can be used as a standard operative procedure for esophagobronchial fistula with esophageal diverticulum.     

An adult case of congenital esophagobronchial fistula accompanied with bronchial branch of the vagal nerve

A case of congenital esophagobronchial fistula in a 73-year-old woman was described. The patient had presented with repeated attacks of pulmonary infection from her childhood and had a several years history of recurrent cough after eating or drinking. Preoperative examinations including esophagogram by barium swallow revealed existence of a fistula between middle thoracic esophagus and right B6 bronchus. The fistula was recognized as Type II of Braimbridge and Keith's classification. The fistula was surgically removed with the atelectatic right lower lobe. Neither adhesion nor enlargement of lymph nodes was found in the surrounding tissues. Because the bronchial branch of vagus was found along the fistula, this lesion was strongly suggested of congenital origin. Histological observations of the resected fistula showed no chronic inflammatory changes, though muscular layers and transitional zone between squamous epithelium and bronchial epithelium were present. The differential diagnosis between the congenital and acquired types is sometimes very difficult. The existence of the bronchial branch of vagus along the fistula means that the fistula is a congenital type, definitely.     

Congenital and acquired esophagobronchial fistula

We report a case of a patient with repeated intractable pneumonia due to congenital and acquired esophagobronchial fistula that was relieved by surgery. The patient was a 69-year-old female, who had repeatedly developed pneumonic symptoms since December 2000. It was found that she had a fistula from an esophageal diverticulum into the right bronchus and was diagnosed with congenital esophagobronchial fistula (Braimbridge classification type I). The patient was not relieved with conservative treatment and the diverticulum and fistula were subsequently excised. Considering the complications, lobectomy was not performed. In postoperative esophagraphy, a second fistula was found at a different site that was then removed during a second surgery. This fistula operation was formed a posteriori based on the conditions around the fistula. We had difficulty with the diagnosis and treatment. However, the patient had a good outcome With surgical treatment. A review of the relevant literature is also presented.     

A case of 72-year-old female with congenital esophago-bronchial fistula

A 72-year-old female with congenital esophago-bronchial fistula is reported. She had complained of cough attack during meals and repeated pneumonia since childhood. A chest x-ray film showed chronic bronchitis in the right lower lung field. Esophagogram revealed a fistula between the esophagus and the right lower lobe bronchus. Resection of the right lower lobe and removal of the fistulous tract were successfully performed. Histological examination of the resected fistula with slight inflammatory change showed muscle layer and transitional zone between the stratified squamous epithelium of esophagus and the ciliated columnar epithelium of bronchus. This is the oldest case in the Japanese literature.     

Experience with surgery for congenital esophago-bronchial fistula with esophageal diverticulum in adult

A 65-year-old female was admitted into our department with complaint of bloody sputum. An upper G-I series examinations and thoracic CT demonstrated an esophago-bronchial fistula with diverticulum located between the mid-esophagus and right B6. Following postero-lateral thoracostomy, the fistula was surgically removed and right lower lobectomy was carried out. No inflammatory changes were found in the surrounding tissues of the fistula and the diverticulum. Histological examination revealed that the fistula wall contained squamous epithelium and muscularis mucosa. These results suggested that this case was congenital esophago-bronchial fistula categorized as Braimbridge type I.     

Successful application of an omental pedicle flap in delayed repair of a perforated esophageal diverticulum: Report of a case

Mediastinitis resulting from a perforated esophageal diverticulum is a potentially fatal complication and the surgical treatment of persistent esophagomediastinal fistula may be difficult. In this report, we describe the successful application of an omental pedicle flap in the delayed repair of a perforated esophageal diverticulum. A 53-year-old man presented with chest and back pain and a diagnosis of perforated esophageal diverticulum was subsequently confirmed. After receiving conservative treatment, he was referred to our department and underwent surgical repair 6 months following the onset of the perforation. Through a right thoracotomy, the mucosal layer of the esophagus around the diverticulum was sutured, and an omental pedicle flap was used to cover the suture line and obliterate the fistulous tract. His postoperative course was uneventful and the suture line healed well. The successful treatment of this patient reinforces our belief that wider application of the omental pedicle flap can be expected in the field of thoracic surgery.     

Esophagobronchial fistula and bronchiectasis arising from traction diverticulosis

Bronchoesophageal fistulas associated with traction diverticula are exceptional. We presented a case of traction diverticulum that fistulized to the bronchial tree and resulted in segmentary bronchiectasis. We encountered a successful repair of esophagobronchial fistula communicated to esophageal diverticulum. To our knowledge, there is no reported case of traction diverticulosis causing esophagobronchial fistula and bronchiectasis in a similar fashion.     

Benign acquired bronchoesophageal fistula in an adult

A 45-year-old woman was admitted to our hospital with a diagnosis of bronchoesophageal fistula, after a barium esophagography performed in an annual medical check-up had demonstrated an esophageal diverticulum in the middle of the thoracic esophagus, having a narrow bridge between the right intermediate bronchi. The patient had a history of tuberculosis in her childhood, and chest radiography showed multiple calcified hilar lymph nodes. The fistula was observed on gastroenteroscopy and on bronchofiberscopy. The patient was treated surgically, with ligation and resection of the fistula. The fistulous tract was attached to a calcified hilar lymph node, and both the diverticulum and fistula were concluded to have been caused by the tuberculous lymphadenitis in her childhood. It is very uncommon to have bronchoesophageal fistula, caused by tuberculosis in childhood, diagnosed and treated surgically at more than forty years later.     

Congenital esophago-bronchial fistula in the adult--a case report

A very rare case of congenital esophago-bronchial fistula in the adult is reported. Sixty-five years old, female. Complaining cough at drinking water and epigastric pain was diagnosed as esophago-bronchial fistula with esophageal diverticulum by Barium swallow and esophagoscopy. The resection of the fistula and diverticulum and the repair were carried out with smooth postoperative course. No evidence of inflammation along the fistula was demonstrated at surgery and microscopic findings of the resected material revealed the direct communication from the squamous epithelium to the cuboidal epithelium with underlying muscle layer in the wall. These results suggested this case the congenital esophago-bronchial fistula (Braimbridge type I).     

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.     

非恶性食管-气管/支气管瘘的外科治疗

目的探讨非恶性食管-气管/支气管瘘的临床特点和处理方法。方法回顾性分析2002年1月至2011年10月北京协和医院收治12例非恶性食管-气管/支气管瘘患者的临床资料,其中男6例,女6例;平均年龄49.8(32～72)岁。食管气管瘘7例,食管支气管瘘1例,食管癌术后胸胃支气管瘘2例,食管憩室支气管瘘2例。右侧开胸入路9例,左侧开胸3例。行食管瘘、气管瘘修补7例;食管瘘、支气管瘘修补1例;胸胃瘘、支气管瘘修补术2例;食管下段、左肺下叶切除,食管胃弓下吻合术1例;左肺下叶切除,食管憩室瘘修补术1例。结果全部患者均顺利恢复,无手术合并症或死亡,7～10 d恢复经口进食。术后3个月～1年内复查纤维支气管镜及上消化道造影,无气管支气管狭窄,无食管狭窄,不必采用支架或扩张治疗。术后随诊3个月～10年,均恢复良好。结论食管-气管/支气管瘘排除恶性病因,明确瘘口位置,术前给予充分营养支持,手术Ⅰ期修补瘘口,可以获得良好的治疗效果。     

A case of congenital esophago-bronchial fistula communicated between esophageal diverticulum and left main bronchus in the adult--a review of 47 cases in the Japanese literature]

We experienced a successful repair of congenital esophago-bronchial fistula communicated between esophageal diverticulum and left main bronchus in adult case. The patient was a 60-year-old female. She had much wet cough on taking meals since 10 years ago. At the mass screening, a esophago-bronchial fistula was detected by upper GI series. Barium esophagography revealed a fistula between esophageal diverticulum and left main bronchus. The resection of diverticulum and fistula were undergone. In the operation, there exited no adhesion or inflammation around the fistula, therefore it was easy to isorate from the surrounding tissues. This case was categorized as Brainbridge type I esophago-bronchial fistula communicated to left main bronchus. Forty-six cases of congenital esophago-bronchial fistula with diverticulum were reported in Japan, but no cases which communicated with left main bronchus were reported. Then it is assumed that this is the first case in Japan.     

Esophagobronchial Fistula Closure Using a Novel Endoscopic Over-the-Scope-Clip

We report on a patient who presented with a symptomatic esophagobronchial fistula arising from an esophageal diverticulum with recurrent pulmonary infections despite prophylactic antibiotics. She was not an optimal candidate for esophageal stenting, bronchial stenting, or surgery and had refused a gastrostomy tube placement. We performed a successful endoscopic fistula closure using a novel endoscopic over-the-scope-clip device providing an effective seal of the fistula with durable resolution of symptoms.     

Unusual midline mandibular fistula

Congenital midline upper lip sinus is a rare lesion. However, congenital midline mandibular skin tag combined lower lip fistula is very rarely reported and described. Therefore, a case report of a congenital midline sinus of the mandibular area in a 6-year-old female is presented. A 6-year-old girl presented with a nipple-like swelling on the mandibular area. Physical examination revealed about 5?×?5 mm protruding round mass with just a small opening that was non-tender to palpation. The tract is excised using probe and dye as the guide. Postoperatively, simple radiologic finding shows retained bony spur on the mandibular symphysis. Microscopic examination of the resected mass revealed the fistulous tract itself, consisting of fibrous connective tissue covered with stratified squamous epithelium, was observed in the center of the sample and especially showed dental component in the peripheral specimen. In the 6-month follow-up, this patient had a good result which was obtained by the method of the excision of the mass and fistulectomy. Level of Evidence: Level V, diagnostic study.     

Tracheal diverticula after tracheoesophageal fistula repair: case series and review of the literature

Background

Tracheoesophageal fistula (TEF) is the most common congenital tracheal abnormality, frequently associated with esophageal atresia. Respiratory symptoms are associated with all types of TEF, even after surgical repair of the fistula. Gastroesophageal reflux (GER) with aspiration of gastric contents, structural instability of the airways (tracheomalacia), abnormal respiratory epithelium, abnormal esophageal motility, recurrent TEF, and esophageal stenosis contribute to postsurgical complications.

Methods

We review 7 patients between 4 and 14 years of age with a history of TEF repair and persistent or worsening respiratory symptoms despite conventional airway clearance techniques and treatment of GER.

Results

Bronchoscopic evaluation in all 7 patients revealed tracheomalacia and a diverticulum on the posterior wall of the trachea at the fistula repair site.

Conclusion

We hypothesize that the diverticula impaired airway clearance and contributed to persistent respiratory symptoms. Possible mechanisms for the diverticulum contributing to poor airway clearance include facilitating the pooling of secretions and acting as a “barrier” to the lower airway clearance mechanism. The diagnosis of a diverticulum should be considered early in patients with persistent respiratory symptoms after management of GER and tracheomalacia. Early obliteration of tracheal diverticula might improve respiratory status in some patients.     

A rare case of congenital bronchoesophageal fistula in an adult

IntroductionWhen congenital bronchoesophageal fistulas exist without atresia of the esophagus, the diagnosis can be delayed, although symptoms may occur early following fistula development. Therefore, while they are usually found in infants, they can be extremely rarely found in adults. We herein report a rare case of bronchoesophageal fistula without atresia in an adult.CaseAn 69-year-old male presented to the outpatient clinic with a decades-long history of cough with expectoration immediately after taking food, especially liquids.Computed tomograph, esophagoscopy, and esophagography revealed the fistulous communication between the mid-esophagus and right lower lobe bronchus, with consolidation in the right lower lobe. We performed right lower lobectomy with the closure and excision of the fistula. The histopathology of the fistula revealed the mucosa to be lined by stratified squamous epithelium. There was no evidence of inflammation, granuloma, or carcinoma.ConclusionIn conclusion, despite the benign nature of this malformation, if left untreated, it can cause long-term debilitating respiratory symptoms associated with the fistula. Therefore, the diagnosis should be considered in the evaluation of recurrent lung infection.     

Horseshoe lung in association with other foregut anomalies: what is the significance?

The authors present an unusual constellation of foregut anomalies in a newborn boy including horseshoe lung, esophageal atresia (EA) with distal tracheoesophageal fistula (TEF), congenital cystic adenomatoid malformation (CCAM), esophagobronchial fistulae, and a preduodenal pancreas. Horseshoe lung is a rare congenital anomaly in which the left and right lung bases are fused across the posterior mediastinum. The presentation is variable. The association of horseshoe lung with VACTERL anomalies and Bronchopulmonary foregut malformations is reviewed. J Pediatr Surg 37:1205-1207.     

Congenital esophagobronchial fistula in an adult

Congenital esophagobronchial fistula occurring in infancy and childhood is a well-recognized entity necessitating urgent surgical treatment. Persistence of such a communication into adulthood is rare and would seem possible only if the tract were small so that aspiration into the lung could be tolerated. The case of a 38-year-old woman is presented in this report who was cured of lifelong symptoms of aspiration by surgical division of a presumed congenital esophagobronchial fistula.     

Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.

Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulization into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.     

Traumatic aorto-right atrial fistula after blunt chest injury

A extremely rare case of traumatic fistula between the aortic root and the right atrium is reported. The patient was involved in a traffic accident 18 months before admission. Aortogram demonstrated a fistulous tract from the noncoronary sinus into the right atrium. Operation revealed a traumatic dissection of the aortic root with rupture into the right atrium. The aortic dissection was repaired and the patient was discharged from the hospital in good condition.