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KMID : 0371319730150060051
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Journal of the Korean Surgical Society
1973 Volume.15 No. 6 p.51 ~ p.58
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Benign Acquired Esophago-Bronchial Fistula
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李泰烈/Lee, Tae Yeul
崔東河/裵洙東/朴海壽/Choi, Dong Ha/Pai, Soo Tong/Park, Hae Soo
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Abstract
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Esophagobronchial fistula due to malignancy is not uncommon condition but of benign nature associated with a stricture of the esophagus is extremely rare condition and only a handful cases were reported in the literature.
A 17 year old scohol boy was admitted in this hospital with a chief complaints of slowly progressing dysphagia of 3 years duration and cough after intake of liquid of two and a half year duration. Five years ago, this boy was seen at a tuberculous clinic with symptoms of mild cough and fever. His chest X-ray then showed complete collapse of the left lower lobe but sputum test was negative for acid-fast bacilli. Apparantly he was assumed to have tuberculosis and subjected to.the antituberc ulous chemotherapy for two and a half years without any appreciable improvement. With exception of usual childhood disease, he has neither family nor past history of any significance.
The patient was small framed and moderately nourished. His weight on admission was 38 kg. Physical examination was all normal except a few moist rales over the left lower base of the chest. Simple chest X-ray revealed atelectasis of the left lower lobe of the lung and thickening of diaphragmatic and mediastinal pleura. These picture was essentially same as the chest X-ray taken five years ago. The trachea and mediastinum appeared to be shifted to the left. Esophagogram showed marked narrowing of the lumen at the lower end with fistulous tract leading to the left lower lobe. Bronchogram also confirmed the presence of fistula between esophagus and one of the branches of the left lower lobe bronchus. Routine laboratory study was all normal.
Thoracotomy revealed a completely collapsed and solid left lower lobe which is densely adherent to the thickened diaphragmatic and mediastinal pleura. A portion of distal esophagus was also solidly
adhered to the mediastinal surface of the-left lower lobe. The lower third of the esophagus was resected together with lower lobe of the left lung with considerable difficulty due to dense inflammatory fibrotic adhesions. Stomach was mobilized and brought up into the thoracic cavity through the opening
n the -left diaphragm and anastomosed to the end of esophagus.
The patient has had uneventful- recovery fro-n surgery and was discharged two weeks later in good general condition and on regular diet.
Patho´_ooy specimen showed a fibrotic stricture at the distal end of esophagus and the fistulous opening with diameter of about 0.5 cm. just proximal to the stricture. Fistulous tract is about 1.5 cm. long and communicates with one of the small abscess cavities in the left lower lobe. There was no evidence of tuberculous or neoplastic process in the resected specimen. The patient is continuing to do well after discharge from the hospital and gained 10 kg. within 5 months following surgery.
It is difficult to determine exact nature of disease in this case but one of the possibility is that this case has had peptic ulcer of distal esophagus which penetrated to the left lower lobe and same time causing the stricture. It may also be possible that this boy had a pyogenic abscess of the left lower lobe to begin with which ruptured into the esophagus causing fistulous communication.
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