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CASE REPORT
Year : 2009  |  Volume : 26  |  Issue : 1  |  Page : 24-25 Table of Contents   

Acquired bronchoesophageal fistula


1 Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
2 Department of Tuberculosis and Respiratory Diseases, Government Medical College, Amritsar, India

Correspondence Address:
Deepak Aggarwal
C/o Mr. Shiv Gulati, House-159, Sector: 35-A, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.45201

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   Abstract 

Bronchoesophageal fistula in an adult is rarely encountered in clinical practice. Most commonly, they have malignant origin. We report a case of bronchoesophageal fistula secondary to trauma caused by upper gastrointestinal endoscopy. The patient presented with recurrent chest infections and dysphagia since he underwent endoscopic procedure for obstructed denture. Barium swallow study revealed fistulous connection between right lower lobe bronchus and esophagus.

Keywords: Bronchoesophageal fistula, endoscopy, dysphagia, acquired


How to cite this article:
Aggarwal D, Mohapatra PR, Malhotra B. Acquired bronchoesophageal fistula. Lung India 2009;26:24-5

How to cite this URL:
Aggarwal D, Mohapatra PR, Malhotra B. Acquired bronchoesophageal fistula. Lung India [serial online] 2009 [cited 2020 Aug 10];26:24-5. Available from: http://www.lungindia.com/text.asp?2009/26/1/24/45201


   Introduction Top


Bronchoesophageal (BE) fistula, as the name suggests, is a communication between bronchus and esophagus. It may be congenital or acquired. Congenital BE fistula has been reported to be 25-50% less common than tracheoesophageal fistula, [1] while the incidence of acquired BE fistula is not known. Acquired causes of BE fistula include malignancies, infections, and traumatic factors like prolonged endotracheal intubation [2] and blunt chest injury. [3] Esophageal foreign bodies resulting in tracheoesophageal fistula have been reported, [4] but association between endoscopy/esophageal foreign body and BE fistula has been scarcely documented in literature. [5]


   Case History Top


A 40-year-old male presented in our OPD with cough, fever, and dysphagia of 2 weeks duration. Cough was accompanied by mucopurulent, nonfoul smelling expectoration, about 30-40 ml/day. The patient had similar complaints for last three years, which started soon after he underwent upper gastrointestinal endoscopy for obstructed denture in the esophagus. Since then, there had been no improvement with antibiotics and symptomatic treatment.

On general examination, the patient was poorly nourished. Chest examination revealed infrascapular rales on the right side. Examination of other systems was unremarkable. X-ray chest showed lower zone heterogenous shadows on the right side [Figure 1] while sputum microscopy was negative for acid fast bacilli. His hemogram, blood sugar, renal, and liver function tests were all within normal limits. To evaluate dysphagia, barium swallow study was done. It revealed barium (contrast) outlining the esophagus, fistulous tract, and the right lower lobe bronchus [Figure 2].


   Discussion Top


BE fistulae in adults are less commonly reported in literature. Congenital BE fistulae are usually diagnosed in neonatal period, but in few cases, they may remain silent till adulthood. [6] Adult BE fistulae are mostly acquired in nature. [2] Their exact incidence has not been reported in India.

Acquired causes of BE fistula include malignancies involving esophagus or adjacent structures. Benign conditions causing fistula are less common and consist of infections like tuberculosis, syphilis, histoplasmosis, actinomycosis, and candidiasis. [2] Tuberculosis being endemic in India should always be considered in the differential diagnosis of BE fistula. Traumatic factors like prolonged endotracheal intubation [2] and blunt chest injury [3] have also been associated with BE fistulae but endoscopic intervention or esophageal foreign body resulting in BE fistula has been rarely documented in literature. [5],[7] Other conditions known to cause fistula include inflammatory conditions like Crohn's disease and Behect's disease, broncholithiasis, and corrosive ingestion [2] .

Acquired fistulae are frequently misdiagnosed. They are characterized by bouts of coughing while eating or drinking (Ohno's sign) and with recurrent pulmonary infections. [2] Delay in diagnosis may be complicated by pneumonia, life-threatening hemoptysis, and respiratory failure. Conventional barium esophagography is considered to be the most sensitive test for diagnosing BE fistula. This investigation provides a definitive diagnosis in 78% of cases. [2]

The acquired nature of the fistula can be proven by demonstrating the acquired cause and by the absence of normal mucosa lining the fistulous tract. The acquired nature of the fistula in our case may be assumed due to the presence of temporal relationship between the endoscopic intervention and the onset of symptoms soon after it. Both, foreign body (denture) and the therapeutic intervention (endoscopy) to treat it could be the cause of BE fistula in our case.

To conclude, acquired BE fistulae can have diverse and rare causes like endoscopic intervention or ingested foreign bodies. High index of suspicion is required to diagnose the fistula and ascertain its cause. The diagnosis should be considered while managing such patients especially when no other cause is evident.

 
   References Top

1.Kim JH, Park KH, Sung SW, Rho JR. Congenital bronchoesophageal fistulas in adult patients. Ann Thorac Surg 1995;60:151-5.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Lim KH, Lim YC, Liam CK, Wong CM. A 52-year-old woman with recurrent hemoptysis. Chest 2001;119:955-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Spalding AR, Burney DP, Richie RE. Acquired benign bronchoesophageal fistulas in the adult. Ann Thorac Surg 1979;28:378-83.  Back to cited text no. 3  [PUBMED]  
4.Darbari A, Suryavanshi A, Tandon S, Chandra G, Singh P. Non malignant Tracheo-Esophageal fistula: Our experience. Indian J Thorac Cardiovasc Surg 2005;21:272-6.  Back to cited text no. 4    
5.Tywonczuk-Szulc M, Kibilda B, Bujnowski T. Case of esophageal foreign body complicated by mediastinitis and broncho-esophageal fistula. Otolaryngol Pol 2004;58:615-8.  Back to cited text no. 5    
6.Iwazawa T, Imazato M, Ohnishi T, Kimura Y, Yano H, Monden T. Double congenital bronchoesophageal fistulae in an adult. Jpn J Thorac Cardiovasc Surg 2004;52:386-9.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Satoh S, Tsugawa C, Tsubota N, Nishijima E, Muraji T. Ingested ring-pull causing bronchoesophageal fistula and transection of the left main bronchus: Successful salvage of the left lung and esophagus five years after injury. J Pediatr Surg 1999;34:1658-60.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]


    Figures

  [Figure 1], [Figure 2]


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