Pediatric esophagopleural fistula: Two case reports and a literature review

Navigating the Confluence of Esophageal Disruption and Pyopneumothorax: A Complex Clinical Encounter

Esophagopleural fistula (EPF) is a rare complication often associated with underlying esophageal malignancies. We present the case of a 64-year-old male who presented with left-sided pyopneumothorax and was diagnosed with EPF secondary to esophageal carcinoma. Imaging studies revealed a hydropneumothorax with an esophageal-pulmonary fistula communicating with the pleural cavity. The diagnosis was confirmed through computed tomography (CT) scan with oral contrast administration, highlighting the utility of this modality in diagnosing EPF. The patient was further referred to the surgical oncology team for esophageal resection and fistula closure.

Iatrogenic Esophagopleural Fistula After the Management of Acute Variceal Hemorrhage With Minnesota Tube Placement

An esophagopleural fistula (EPF) is a rare condition. EPFs are typically of spontaneous, iatrogenic, or neoplastic origin. A 50-year-old man with hepatitis C and alcoholic cirrhosis presented with a history of recurrent variceal hemorrhage requiring esophageal banding, Minnesota tube placement, and a transjugular intrahepatic portosystemic shunt. His hospital course after esophageal perforation and EPF was complicated by acute respiratory failure and empyema, necessitating intubation and thoracostomy tube placement. To the best of our knowledge, this is the first reported case of EPF secondary to Minnesota tube placement. The EPF completely healed after endoscopic repair.

Delayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices: A case report

RATIONALE

Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high.

PATIENT CONCERNS

An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding.

DIAGNOSES

Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula.

INTERVENTIONS

The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids).

OUTCOMES

The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments.

LESSONS

This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.