Surgical Management of Post-Esophagectomy Tracheo-Bronchial-Esophageal Fistula

Balakrishnan, Ashwin; Tapias, Leonidas; Wright, Cameron D.; Lanuti, Michael; Gaissert, Henning A.; Mathisen, Douglas J.; Muniappan, Ashok

doi:10.1016/j.athoracsur.2018.06.076

Cited by 29 publications

(32 citation statements)

References 21 publications

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“…Rarely, esophagectomy can be complicated by fistula formation, which connects the gastrointestinal (GI) tract with the surrounding structures. Case reports in the literature describe fistulas that connect the esophagus or stomach to the airway, aorta, pleura, or pericardium [6][7][8]. In this report, we describe a case of esophagopericardial fistula after esophagectomy.…”

Section: Introductionmentioning

confidence: 82%

Esophagopericardial Fistula After Esophagectomy

Khader

Ghazaleh

Nehme

et al. 2021

Cureus

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Esophagectomy is the mainstay surgical treatment for esophageal carcinoma. The operation can be complicated by an anastomotic stricture, anastomotic leak, recurrent laryngeal nerve injury, conduit ischemia, and chylothorax. Rarely, esophagectomy can be complicated by fistula formation between the gastrointestinal tract and the nearby structures. We describe a case of esophagopericardial fistula after esophagectomy. A 50-year-old man presented to the emergency room with a chest pain of two-week duration associated with sweating, chills, and poor appetite. He was diagnosed with stage III esophageal adenocarcinoma four months ago. He had received neoadjuvant chemotherapy followed by distal esophagectomy, partial gastrectomy, and placement of a jejunostomy tube one month before presentation. Cardiovascular examination was significant for jugular venous distention and distant heart sounds. Chest CT angiography showed pneumomediastinum concerning for anastomotic leak. Esophagram finally confirmed an esophagopericardial fistula. A drain was placed into the pericardial space followed by emergent esophageal stent placement. Eventually, he underwent a cervical esophagostomy and placement of a jejunostomy tube. The patient was later discharged home in a stable condition. In conclusion, esophagopericardial fistula is a rare adverse event of esophagectomy. Esophageal stenting could be useful as a temporary or definite treatment.

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Section: Introductionmentioning

confidence: 82%

Esophagopericardial Fistula After Esophagectomy

Khader

Ghazaleh

Nehme

et al. 2021

Cureus

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“…Therefore, the tinier fistula directed towards the right lower lobe could not be detected. Majority of acquired TEFs were reported to be related with anastomotic leakage, not only in esophageal atresia, but also in other diseases such as esophageal cancer [8,9]. This suggests that severe inflammation derived from a leakage could form a fistula.…”

Section: Discussionmentioning

confidence: 99%

Post-esophageal atresia repair double acquired tracheoesophageal fistulas treated successfully by gastric transposition: a case report

et al. 2020

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Background Postoperative recurrence of tracheoesophageal fistula (TEF) is a frequent complication in the repair of esophageal atresia (EA). Based on the recent etiologic classification, a TEF that develops in a different new pathway from the original one is categorized as an acquired TEF. The TEFs that fall into this category have been reported to be refractory and their mechanisms have not been fully understood. Here, we report the complicated case of an acquired TEF derived from mediastinitis after the original TEF repair developed an anastomotic stricture. The TEF contained double fistulas, both towards the right lobe bronchi, and was repaired by gastric transposition through a retrosternal route. Case presentation The patient was diagnosed with Gross C esophageal atresia after birth and underwent tracheoesophageal fistula banding during the neonatal period. He experienced an intractable anastomotic stenosis after surgery which was treated with repeated balloon dilation therapy. By the age of 11 months, he developed a mediastinal abscess that improved with conservative treatment. At 18 months old, a fistula from the esophagus to the right superior lobe bronchus was identified. The patient underwent a right upper lobectomy to resect the fistula. However, at 21 months old, another fistula to the right lower lobe was revealed. An esophageal banding was done to relieve the respiratory symptoms. This was followed by esophagectomy and gastric transposition through the retrosternal route at 26 months old. The patient started rehabilitation and oral intake gradually after surgery. By 3 years after gastric transposition, he could already take blended food orally with the support of small amounts of enteral feeding. Conclusion Cases of TEF derived from severe inflammation have the potential to form a complicated network and lead to recurrence. Surgeons should consider the possibility of multiple tiny fistulas in cases of severe acquired TEF. These may be repaired successfully by gastric transposition through the retrosternal route.

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“…We appreciate the insightful comments and questions by Bergeat and colleagues [1] regarding our article [2]. Dr Bergeat's group described an innovative technique using a pedicled intercostal myocutaneous flap to close postesophagectomy airway fistulas [3].…”

Section: Reply To the Editormentioning

confidence: 96%

“…We read with great interest the article on treating postesophagectomy tracheobronchial esophageal fistula (PETEF) surgical management in 11 patients [1]. This article highlights the difficulties of such management, reporting a 25% death rate and a 50% recurrence rate after salvage surgery.…”

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confidence: 99%