Oesophagopleural Fistula - a Rare Sequel of Pneumonectomy

Abstract

Postpneumonectomy oesophagopleural fistula (OPF) is a devastating situation occurring in 0.2-1.0% of the patients undergoing pneumonectomy. Distinction is made between OPF appearing after pneumonectomy for chronic inflammation and suppuration, and OPF after pneumonectomy for lung cancer. Early and late fistulas (the former appearing within three months of the operation) are found in both groups. We report a case of OPF occurring almost five years after pneumonectomy for malignant lymphoma of the lung. Common signs of OPF are postpneumonectomy empyema and presence of previously ingested food particles in the empyema cavity. Treatment is extremely difficult and prolonged, and often not successful. Amelioration of the nutritional status, drainage of the postpneumonectomy space and closure of the fistula by injecting a sclerosing substance should be attempted. If this fails, the fistula should be closed by direct suture reinforced by a muscular or omental flap.

Postoperative complications after thoracic surgery for lung cancer

“…Esophagopleural fistula (EPF) occurs in 0.2-1.0% of patients after pneumonectomy and can result from intraoperative esophageal injury, mediastinal cancer recurrence, and/or chronic infection [64,65]. When associated with cancer recurrence, which is the case in approximately half of all EPFs, the prognosis is very poor [16].…”

“…When associated with cancer recurrence, which is the case in approximately half of all EPFs, the prognosis is very poor [16]. Most of these fistulas occur within the first two years after stopping cancer treatment [64,65].…”

“…Common signs of EPF are postpneumonectomy empyema and the presence of previously ingested food particles in the empyema cavity [65]. Diagnosis with CXR is limited, as a fistulous tract cannot be suggested until the empyema space contains air [16].…”

Imaging in postpneumonectomy complications: A pictorial review

“…In the late postoperative period, either recurrent tumor or chronic inflammation in the esophagus, bronchial stump, or surrounding tissues may be the causal mechanism. [3,23] When the fistula is large, food particles appear in the drainage fluid and the diagnosis is straightforward. Smaller leaks tend to cause chronic empyema and are difficult to detect.…”

Successful treatment of patient with esophagopleural fistula by performing esophageal stenting and thoracoscopy

“…Одним из тяжелых осложнений пневмонэкто-мии является формирование пищеводно-плевраль-ного свища [1,2]. Стойкая персистенция симпто-мов, рецидивирующий характер, исходно неблаго-приятные условия для заживления в виде остаточ-ной плевральной полости и гнойного воспаления создают сложности в выборе оптимального способа лечения пациентов [3].…”