Congenital esophagobronchial fistula communicated to esophageal diverticulum, report of a case

We encountered a successful repair of congenital esophagobronchial fistula communicated to esophageal diverticulum. A 35 year-old-female has had frequent episodes of pneumonia since her 1st delivery. Barium esophagogram revealed a fistulous tract between the esophageal diverticulum and the right lower lobe bronchus. Bronchogram showed a ectatic dilatation at B6a and B6c. The resection of diverticulum and right lower lobectomy including the removal of fistulous tract were carried out. Histological examination of the resected fistula revealed a smooth connection between squamous epithelium and columnar epithelium. And muscularis mucosa was maintained with no evidence of inflammatory changes. So this case was diagnosed a Braimbridge I type esophagobronchial fistula. In Japan 21 cases of congenital esophagobronchial fistula with diverticulum have been reported. It is assumed that three histological findings as mentioned above is important for the diagnosis of congenital esophagobronchial fistula.     

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).     

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.     

Advanced esophageal cancer with an esophago-bronchial fistula successfully treated by chemoradiotherapy following esophageal bypass surgery: report of a case

Esophageal bypass surgery using a gastric tube prior to definitive chemoradiotherapy in preparation for the formation of esophago-tracheal or bronchial fistula is a possible strategy for esophageal cancer invading the airway. This report presents the case of a patient with esophageal cancer involving the left main bronchus who underwent esophageal bypass followed by definitive chemoradiotherapy and who has achieved long-term survival without deterioration of his quality of life, in spite of the development of a malignant esophago-bronchial fistula.     

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.     

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.     

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.     

食管穿孔和破裂的诊断与治疗

目的 提高对食管穿孔和破裂的诊断及处理水平。方法 回顾性分析经外科处理的45例食管穿孔或破裂患的临床资料。结果 本组患经胸部平片、胸腔穿刺、上消化道造影及胃镜确诊。15例为自发性食管破裂，6例为医源性穿孔，5例为创伤性穿孔，10例为食管癌并食管支气管瘘，9例为食管憩室并食管支气管瘘。治疗予以食管修补9例；胸腔引流、空肠造瘘9例(其中1例为食管修补失败后改行此手术)；食管切除胃食管吻合术12例(其中3例为食管修补失败)；胃造瘘术4例；置入食管支架4例；食管支气管瘘切除修补3例；食管瘘口修补并肺叶切除2例；食管胃弓上短路1例，颈部引流2例；放弃治疗3例。治愈25例，好转11例，死亡6例。结论 详细了解病史和进行胸腔穿刺、上消化道造影等检查可帮助诊断。尽早手术闭合瘘口和治疗食管原发病变是治疗的关键。     

Congenital respiratory-esophageal fistula in the adult. Report of nine cases and review of the literature.

Congenital tracheoesophageal or bronchoesophageal fistulas, if not associated with esophageal atresia, may not appear initially until adult life. Nine such cases (two tracheoesophageal and seven bronchoesophageal) are reported. The chief presenting symptoms were recurrent bouts of coughing, after drinking, and hemoptysis. In the majority of cases the duration of symptoms exceeded 15 years. The diagnosis was confirmed in seven patients by esophagography, in one patient by bronchoscopy, and in one patient the fistula was discovered incidentally during thoracotomy. The esophageal opening of the fistula was in the lower third in seven patients and in the middle third in two. Bronchoesophageal fistulas communicated with a segmental bronchus in four patients and with a main or lobar bronchus in three. Treatment involved excision of the fistula (five patients) or division and suturing (four patients). Postoperative follow-up revealed no long-term sequelae except persistent chronic respiratory failure in one patient. The respiratory failure had developed before treatment of the fistula. The analysis of this series and a review of the literature underline the high index of suspicion required in all cases of chronic cough and lung suppuration, to diagnose this benign condition before life-threatening complications occur.     

Congenital broncho-oesophageal fistula in the adult.

The case of a 46-year-old man with congenital broncho-oesophageal fistula is presented. The patient had had recurrent chest infections since childhood and a recent history of heartburn and flatulence. A barium-swallow examination showed a small sliding hiatal hernia and an oesophageal diverticulum communicating via a fistula with the apical and posterior segmental bronchi of the left lower lobe. Bronchography showed bronchiectasis in this lobe. At thoracotomy resection of the broncho-oesophageal fistula and left lower lobectomy were performed. The patient''s recovery was uneventful. Twenty published cases are reviewed. The classification of congenital broncho-oesophageal fistulae should take account not only of the type of fistula but also of the type and size of the bronchus with which the fistula communicates, the age of the patient at the first appearance of symptoms, and the duration of symptoms.     

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.     

Congenital anterior urethral diverticulum: report of a case

A case of congenital urethral diverticulum is reported. A 6-month-old male was admitted with difficulty to urinate and swelling of the base of penile shaft. Anterior urethral diverticulum was demonstrated by means of retrograde urethrography. A diverticulectomy combined with cystostomy was performed under the general anesthesia. Although the histological findings were insufficient to determine whether the urethral diverticulum was congenital or acquired, the former was strongly suspected judging from his clinical course. He developed urethrocutaneous fistula, one of the most common postoperative complication, on the 7th post-operative day. A complete cure of the fistula was achieved by the conservative treatment. We collected and analyzed 49 cases of congenital anterior urethral diverticulum of male children in Japan.     

经腹腔镜微创治疗膈上食管憩室

目的探讨经腹腔镜微创治疗膈上食管憩室的可行性与有效性。 方法回顾性分析2015年1月至2020年6月于上海市胸科医院治疗的31例食管憩室患者,分析其中13例膈上食管憩室。术前辅助诊断检查包括钡餐造影、上消化道内镜检查、24 h食管pH监测以及食道Manometry测压。手术方式包括病例1~2经左胸开放,病例3经右胸腔镜,病例4~13经腹腔镜裂孔完成。术后观察指标包括手术相关并发症以及症状缓解情况。 结果13例膈上食管憩室中男7名（53.8%）,年龄（64.08±5.9）岁,10例（76.9%）憩室朝向食管左侧壁,憩室颈上缘距门齿距离（35.8±2.0）cm,憩室体直径（4.5±1.7）cm。13例患者接受手术治疗,手术时间（122.1±45.7）min,手术失血量（115.4±60.5）mL,住院时间（10.0±3.4） d。术后发生食管瘘3例,左胸（50%）、右胸（100%）、经腹（10%）路径各1例,其中2例经胸瘘患者均需二次手术。无院内死亡。远期随访可见左胸路径术后有1例患者出现食管狭窄,右胸路径术后1例患者出现反流,腹腔镜术后有2例患者出现食管狭窄。 结论腹腔镜经裂孔治疗膈上食管憩室,可以极大地提高手术安全性,通过解除远端梗阻,极大地降低术后瘘和憩室复发的发生率。     

Benign broncho-esophageal fistula in the adult

BACKGROUND: Benign broncho-esophageal fistula (BEF) in the adult is rare, and occurs as a complication of inflammatory disorders, foreign body ingestion, or congenital anomalies. Nonspecific symptoms lead to a delay in diagnosis. METHODS: The charts of 13 patients from 1960 to 2001 at the Massachusetts General Hospital were retrospectively reviewed. RESULTS: Nine patients had chronic cough, which worsened upon ingestion. Four patients developed BEF after prior thoracic surgery, and 3 after histoplasmosis. Silicosis, foreign body ingestion, lye ingestion, bronchogenic cyst, esophageal diverticulum, and a congenital anomaly caused BEF in 1 patient each. Barium swallow was the most useful diagnostic test. Fistulas most often arose from the right bronchial tree and communicated with the distal esophagus. Management involved excision of the tract, primary closure of the bronchus and esophagus, and interposition of vascularized tissue. There was one perioperative failure, but no long-term recurrences after successful surgical closure. CONCLUSIONS: The majority of benign BEF in adults are acquired, and result from mediastinal inflammation. Accurate recognition and surgical closure prevents persistent uncontrolled aspiration and pulmonary sepsis.     

Esophageal bypass operation of a patient with esophageal stenosis and esophago-bronchial fistula due to lung cancer]

Esophageal bypass operation was carried out for a patient with lung cancer who was not able to take oral feeding, due to esophageal stenosis and esophago-bronchial fistula. Stomach was used as a esophageal substitute, through antethoracal route. Abdominal esophago-jejunostomy was performed for drainage of esophago-bronchial fistula. Oral intake of foods was started from 11th postoperative day without major complication. And then, she was permitted to discharge only with a jejunostomal feeding tube. Recently the quality of life is emphasized, even in cases in which curativity of cancer cannot be expected. Surgery in such cases entails many risks and then, special care must be taken to determine the indication and procedure of this operation. In the case herein reported, such attention to detail resulted in survival for over one year.     

A successfully treated case of empyema with a large tracheal fistula after a radical operation of esophageal cancer by fixation and plombage with major pectoral muscle flap]

We reported a successfully treated case of empyema with a large tracheal fistula which had developed after a radical operation of esophageal cancer (reconstructed with stomach). This 59-year-old male was treated by the method of fixation and plombage with major pectoral muscle flap and thoracoplasty, because we could not use the omentum that were frequently used nowadays for closure of the fistula. The size of the tracheal fistula was a large as the main bronchus bronchoscopically. Postoperative care were the following, the endotracheal tube was inserted from the tracheal stoma to the left main bronchus and 9 days left hemi-ventilation was performed. Continuous suction was performed at the same time from the right main bronchus in order to prevent secretion and blood pour into the left lung. Bronchoscopical examination done 28 postoperative day, the small fistula remained the tip of the muscle flap. But 72 postoperative day, the surface of the fixed muscle flap was replaced by normal bronchial mucomembrane and tracheal fistula was obliterated. Major pectoral muscle could be used as local flap to obliterate empyema cavity associated with tracheal fistula. We believe that utilizing an muscle flap for those who had undergone abdominal operation like our case is a valuable method.     

Endobronchial stenting as a palliation for advanced esophageal cancer

Three cases of airway invasion of esophageal cancer treated palliatively by endobronchial stenting are reported. In case 1 (a 60-year-old male) expandable metallic stents were inserted into the totally occluded left main bronchus. In case 2 (a 45-year-old male) a Dumon stent was inserted into the totally occluded left main bronchus. Both patients recovered from performance status 4 to performance status 1 or 0 and were in good condition before they died of cancer, 150 and 54 days after stenting in cases 1 and 2, respectively. In case 3, a Dumon stent was inserted into the left main bronchus before total occlusion. The patient recovered from performance status 3 or 2 to performance status 1 or 0 and survived 40 days after stenting with no signs of airway obstruction. Endobronchial stenting is a useful palliation for keeping the performance status at a good level in patients with esophageal cancer obstructing or narrowing the main airway.     

Endobronchial stenting as a palliation for advanced esophageal cancer.

Three cases of airway invasion of esophageal cancer treated palliatively by endobronchial stenting are reported. In case 1 (a 60-year-old male) expandable metallic stents were inserted into the totally occluded left main bronchus. In case 2 (a 45-year-old male) a Dumon stent was inserted into the totally occluded left main bronchus. Both patients recovered from performance status 4 to performance status 1 or 0 and were in good condition before they died of cancer, 150 and 54 days after stenting in cases 1 and 2, respectively. In case 3, a Dumon stent was inserted into the left main bronchus before total occlusion. The patient recovered from performance status 3 or 2 to performance status 1 or 0 and survived 40 days after stenting with no signs of airway obstruction. Endobronchial stenting is a useful palliation for keeping the performance status at a good level in patients with esophageal cancer obstructing or narrowing the main airway.     

Ingested ring-pull causing bronchoesophageal fistula and transection of the left main bronchus: successful salvage of the left lung and esophagus five years after injury

A 6-year-old girl with a history of ingestion of a ring-pull of a can and a transient episode of stridor had been asymptomatic 3 years before admission when left lung atelectasis with severe respiratory distress developed. Fluoroscopy and 3-dimensional computed tomography scan showed bronchoesophageal fistula and the ring-pull around the left main bronchus. At operation, the ring-pull, which transected the left main bronchus, was extracted. The left main bronchus was reconstructed by end-to-end anastomosis in spite of insufficient inflation of the collapsed left lung. The esophageal defect was repaired. The patient's respiratory distress gradually disappeared, and the x-ray films 3 months after operation showed complete expansion of the left lung. This case shows the risk of the long-term retained esophageal foreign body and the possibility of pulmonary salvage after long-term total atelectasis of the lung.     

Esophago-bronchial fistula confirmed with bronchoscopy utilized an indocyanine green

The patient was a 54-year-old female with both headache and vomit presented to the emergency room. Endoscopic examination revealed an advanced esophageal cancer located on the middle thoracic esophagus. Histological analysis revealed squamous cell carcinoma. The clinical stage was diagnosed as T4N2M0 and this case was treated by the chemoradiation. She presented progressive moist cough after chemoradiotherapy. Esophagography demonstrated esophago-bronchial fistula (EBF). EBF was not detected by routine broncoscopy. To confirm fistula, we were performed the bronchoscopy which utilized an indocyanine green. Contrast media colored green were over from the superior segmental bronchus in a bronchoscope. The bronchoscope which utilized an indocyanine green is effective for EBF.