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Adult Benign, Non-Iatrogenic Bronchoesophageal Fistulae: Systematic Review and Descriptive Analysis of Individual Patient Data. World J Surg 2021; 45:3449-3457. [PMID: 34370057 DOI: 10.1007/s00268-021-06266-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adult, benign, non-iatrogenic bronchoesophageal fistula (BEF) is a rare condition, which is occasionally described in single case reports. Therefore, little is known about its possible causes, presentation and management. METHODS A systematic search of the literature in MEDLINE, PubMed Central and EMBASE databases between 1990 and 2020 was carried out to identify all cases of BEF. The initial database search identified 19,452 articles, of which 183 (251 individual patient cases) were included in the final analysis. RESULTS Main causes of BEF were congenital malformations (97/251, 38.7%) and infections (82/251, 32.7%), while 33/251 (13.1%) fistulae were regarded as idiopathic and 39/251 (15.5%) attributed to other causes. Esophagograpy was the most sensitive method of diagnosis (97.4%) compared with esophagoscopy (78.9%), computed tomography (49.6%) and bronchoscopy (46.0%). Definitive treatment was surgical for 176 patients (70%), endoscopic for 25 (10%) and medical for 37 (14.7%). Compared with congenital BEFs, infective BEFs had shorter median symptom duration and were distributed more proximally over the bronchial tree. Definitive treatment was almost only surgical for congenital BEFs, while infective BEFs were treated also endoscopically (12%) and by medical therapy (38%). Morbidity, treatment failure and recurrence rates were higher for infective BEFs. CONCLUSIONS BEFs are rare. Symptoms are non-specific and a high index of suspicion is necessary for diagnosis. Patients with infective BEF tend to have a more severe clinical picture than those with congenital BEF. Surgery is the main treatment for patients affected by congenital BEF, while infective BEFs may heal conservatively.
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Nishimura T, Fuse C, Akita M, Takase N, Maeda E, Abe K, Kozuki A, Yokoyama K, Tanaka T, Kishi S, Sakamoto T, Sakai T, Kaneda K. A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer. Surg Case Rep 2021; 7:95. [PMID: 33856574 PMCID: PMC8050132 DOI: 10.1186/s40792-021-01178-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/09/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gastrobronchial fistulas are rare, but life-threatening, complications of esophagectomy. They are caused by anastomotic leakage and mainly occur around anastomotic sites. In the present paper, we report a rare case of leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer, which was successfully treated using an intercostal muscle flap and lung resection. CASE PRESENTATION A 61-year-old male underwent subtotal esophagectomy with regional lymphadenectomy for esophageal cancer. The sutures along the staple line of the gastric tube failed 11 days after surgery, and a pulmonary abscess was also found on imaging. The abscess did not heal after conservative treatment; therefore, right lower lobectomy, gastrobronchial fistula resection, primary closure, and patching of the leaking portion of the gastric tube with an intercostal muscle flap were performed 9 months after the first operation. The patient's postoperative course was uneventful, and he was discharged on the 354th day. CONCLUSIONS We experienced a case involving a gastrobronchial fistula caused by leakage from the staple line of a gastric tube and successfully treated it by performing right lower lobectomy and patching the leak with an intercostal muscle flap.
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Affiliation(s)
- Tohru Nishimura
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan.
| | - Chisakou Fuse
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Masayuki Akita
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Nobuhisa Takase
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Eri Maeda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Koichiro Abe
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Akihito Kozuki
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Kunio Yokoyama
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Tomohiro Tanaka
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Shinji Kishi
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Toshihiko Sakamoto
- Department of Thoracic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Tetsuya Sakai
- Department of Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Kunihiko Kaneda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
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Esophageal bypass surgery as a definitive repair of recurrent acquired benign bronchoesophageal fistula. J Cardiothorac Surg 2019; 14:73. [PMID: 30971283 PMCID: PMC6458707 DOI: 10.1186/s13019-019-0902-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acquired benign bronchoesophageal fistula (BEF) is rare and develops as a complication of other diseases, mostly of inflammatory processes and traumas of the chest. The treatment of choice is a surgical repair, which is considered definitive and leads to successful outcomes. However, incidence of recurrence after the primary repair based on limited data is up to 10% and its treatment is challenging. We report a surgical case of a patient with recurrent acquired benign BEF after primary resection and ensuing successful definitive repair with esophageal bypass surgery after temporary esophageal stenting. Case report A 46-year-old male was referred to our department with a symptomatic left-sided bronchoesophageal fistula as a complication of severe acute necrotizing mediastinitis that originated from odontogenic abscess. Previously, several cervicotomies and bilateral thoracotomy were performed at an external medical facility to manage the acute condition. We performed resection of the fistula through re-thoracotomy. Postprocedural esophagography demonstrated a recurrence of bronchoesophageal communication. Postinflammatory adhesions excluded further repair through thoracotomy, therefore a stent was introduced in the esophagus for 12 weeks. Thereafter, an esophageal bypass surgery using a substernaly interposed gastric conduit was performed and resulted in an excellent long-term outcome. Conclusions Esophageal bypass surgery using a substernaly interposed gastric conduit may be considered if the standard surgical repair of acquired benign bronchoesophageal fistula is not successful or feasible.
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Akaraviputh T, Angkurawaranon C, Phanchaipetch T, Lohsiriwat V, Nimmanwudipong T, Chinswangwatanakul V, Metasate A, Trakarnsanga A, Swangsri J, Taweerutchana V. Platysma myocutaneous flap interposition in surgical management of large acquired post-traumatic tracheoesophageal fistula: A case report. Int J Surg Case Rep 2014; 5:282-6. [PMID: 24727740 DOI: 10.1016/j.ijscr.2014.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acquired post-traumatic tracheoesophageal fistula (TEF) is an uncommon entity requiring early diagnosis. Among the many strategies in surgical management, we report a case successfully treated with a single-stage tracheal resection and esophageal repair with platysma myocutaneous interposition flap. PRESENTATION OF CASE A 24-year-old man had a motor vehicle accident with head injury and cerebral contusion who required mechanical ventilation support. Three weeks later, he developed hypersecretion, and recurrent episodes of aspiration pneumonia. The chest computed tomography, esophagogastroduodenoscopy, and bronchoscopy revealed a large TEF diameter of 3cm at 4.5cm from carina. Single-stage tracheal resection with primary end-to-end anastomosis and esophageal repair with platysma myocutaneous interposition flap was performed. A contrast esophagography was done on post-operative day 7 and revealed no leakage. He was discharged on post-operative day 10. Esophagogastroduodenoscopy at 1 month revealed patient esophageal lumen. At present he is doing well without any evidence of complications such as esophageal stricture or fistula. DISCUSSION There are many choices of myocutaneous muscle flaps in trachea and esophageal closure or reinforcement. The platysma myocutaneous flap interposition is simple with the advantage of reduced bulkiness. Concern on the vascular supply is that flap should be elevated with the deep adipofascial tissue under the platysma to ensure that the flap survival is not threatened. CONCLUSION The treatment of acquired TEF with platysma myocutaneous flap is an alternative procedure for a large uncomplicated TEF as it is effective, technically ease, minimal donor site defect and yields good surgical results.
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Affiliation(s)
- Thawatchai Akaraviputh
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Chotirot Angkurawaranon
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Teerawit Phanchaipetch
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Visnu Lohsiriwat
- Division of Head Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanyadej Nimmanwudipong
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Asada Metasate
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Voraboot Taweerutchana
- Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Madan K, Venkatnarayan K, Shalimar, Mohan A. Successful medical management of tuberculous broncho-oesophageal fistula. BMJ Case Rep 2014; 2014:bcr-2013-202560. [PMID: 24623363 DOI: 10.1136/bcr-2013-202560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Broncho-oesophageal fistula (BEF) of benign aetiology is rare. BEF is a rare complication of intrathoracic involvement with tuberculosis. A high index of suspicion and appropriate investigations can lead to achieving an early diagnosis following which appropriate management can be timely instituted. Surgery can be avoided if the condition is recognised in early stages. We present a case of a young female patient with tubercular mediastinal lymphadenopathy complicated by left broncho-oesophageal fistulisation. Timely initiation of conservative medical management was followed by an uneventful recovery.
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Affiliation(s)
- Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Esophagobronchial fistula closure using a novel endoscopic over-the-scope-clip. Ann Thorac Surg 2012; 94:e69-70. [PMID: 22916783 DOI: 10.1016/j.athoracsur.2012.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/08/2012] [Accepted: 02/02/2012] [Indexed: 12/22/2022]
Abstract
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.
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Ahn JY, Jung HY, Choi JY, Kim MY, Lee JH, Choi KS, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH. Benign bronchoesophageal fistula in adults: endoscopic closure as primary treatment. Gut Liver 2010; 4:508-13. [PMID: 21253300 DOI: 10.5009/gnl.2010.4.4.508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 07/17/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS Benign bronchoesophageal fistula (BEF) is a rare condition that is usually treated surgically; however, less invasive endoscopy procedures have been attempted to overcome the disadvantages of surgery. The aim of this study was thus to determine the results of endoscopic management as a primary treatment in patients with BEF. METHODS We retrospectively analyzed data from 368 patients with BEF who were treated at a tertiary care, academic medical center between January 2000 and August 2009. RESULTS Benign causes were found for only 18 of the 368 patients. Of these, seven were treated endoscopically and the others by surgery or other methods. The first endoscopy procedures failed in all seven patients, with second trials of endoscopy performed in four patients at a median of 8 days (range, 3 to 11 days) after the first procedure. The second endoscopic procedure was successful in two out of four patients; one patient showed no recurrence of the fistula, whereas the second patient experienced a recurrence after 24 months. All patients underwent successful surgical procedures after the failure of endoscopic treatment, with no further recurrences. CONCLUSIONS Although we observed a low rate of success for primary endoscopic treatment of benign BEF, the invasive nature of surgery suggests the need for a prospective study with a large number of patients to evaluate the efficacy of less invasive procedures such as endoscopic treatment.
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Affiliation(s)
- Ji Yong Ahn
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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