Three Cases of Surgical Repair of Benign Esophagotracheal Fistula Caused by Different Etiologies

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  • Iwasaki Hiroshi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Osugi Harushi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Takemura Masashi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Lee Shigeru
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Kishida Satoru
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Fukuhara Kenichiro
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Nishizawa Satoshi
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Gyobu Ken
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine
  • Yoshida Kayo
    Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine

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Other Title
  • 成因の異なる良性食道気道瘻３例の外科治療
  • 症例報告 成因の異なる良性食道気道瘻3例の外科治療
  • ショウレイ ホウコク セイイン ノ コトナル リョウセイ ショクドウ キドウロウ3レイ ノ ゲカ チリョウ

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Three cases of surgical repair of benign esophagotracheal fistula caused by different etiologies were reported. Case 1 was a 63-year-old male who presented with cough and chest pain 1 year after 60 Gy external irradiation and 10 Gy intraluminal irradiation for superficial esophageal cancer. Endoscopy revealed a fistula between the midesophagus and left main bronchus, and biopsy showed no tumor involvement at the fistula. After failure of packing with intraesophageal stenting, an operation was performed through right thoracotomy. The fistula was closed using the adjacent esophageal wall, and subtotal esophagectomy and lymphadenectomy were performed. Because no tumor was found histologically, the fistula was caused by radiation damage. Case 2 was a 56-year-old male referred to us for further evaluation of repeated pneumonia of the left lower lobe after cholecystectomy, which required endotracheal intubation for anesthesia. Contrast study of the esophagus revealed a fistula between the bottom of the diverticulum, which had been known to be associated, and the left main bronchus. Under left thoracotomy, diverticulectomy was performed together with left lower lobectomy, because of carnification of the lobe due to repeated inflammation. Histological evaluation established a diagnosis of an esophagobronchial fistula classified as Braimbridge type I. Case 3 was a 31-year-old male referred to us for evaluation of cough on ingestion after a traffic-induced chest injury. Endoscopic observation revealed an esophagotracheal fistula. Under right thoracotomy, the fistula was closed using the adjacent esophageal wall. The defect of the remnant esophagus was closed by Gambee’s suture. The etiology of the fistula was thought to be traumatic. In cases of benign esophagotracheal fistula, intraesophageal stenting seldom packs the fistula. Operative sectioning is most useful for treating benign esophagotracheal fistulas.

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