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

Abstract

Background The 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 presentation A 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. Conclusion When 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.

A Successful Treatment of Broncho-Esophageal Fistula with Esophageal Stenting Using Direct Endoscopic Visualization

“…Broncho-esophageal fistula (BEF) is an uncommon condition resulting from an abnormal connection between the bronchus and the esophagus that can be either congenital or acquired (Figure 1). In adults, congenital fistulas are quite rare; therefore, the occurrence of such cases usually suggests an acquired condition of benign (infections, chest traumatic events, prolonged endotracheal intubation) or malignant (esophagus, bronchi, mediastinum, lungs) origin [1,2]. Malignancy-associated broncho-esophageal fistulas may occur due to tumor infiltration and subsequent rupture, or as a result of radiation, laser therapy, chemotherapy, pre-existing stents (particularly esophageal stents), or a combination of these factors [3]; however, compared to tracheoesophageal fistulas, they are much rarer, with very few cases reported in the medical literature, which makes their diagnosis either delayed or inaccurate [4].…”