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

Iwasaki Hiroshi, Osugi Harushi, Takemura Masashi, Lee Shigeru, Kishida Satoru, Fukuhara Kenichiro, Nishizawa Satoshi, Gyobu Ken, Yoshida Kayo

doi:10.2468/jbes.57.508

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.

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

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