Kosin Med J.  2018 Dec;33(3):386-390. 10.7180/kmj.2018.33.3.386.

Congenital bronchoesophageal fistula in an adult: a case report and radiologic review

• Kim BS
• Kang EJ
• Lee KN
• Choi PJ

• KMID: 2442549
• DOI: http://doi.org/10.7180/kmj.2018.33.3.386

Abstract

Congenital bronchoesophageal fistula (BEF) is rarely reported in adults in the English literature. Herein, we present a rare case of congenital BEF in a 43-year-old man that was incidentally found on esophagogastroduodenoscopy. Chest CT and barium esophagography revealed a fistula between his lower esophagus and the right lower lobe segmental bronchus. After the fistula was surgically treated, the fistula was no longer noted on follow-up barium esophagography.

Keyword

Bronchoesophageal fistula; Congenital; CT Esophagography

MeSH Terms

Adult*
Barium
Bronchi
Endoscopy, Digestive System
Esophagus
Fistula*
Follow-Up Studies
Humans
Tomography, X-Ray Computed
Barium

Figure

• 

  Fig. 1 A 43-year-old man with an incidentally detected fistulous opening at the lower third of esophagus on esophagogastroduodenoscopy. (A) Esophagogastroduodenoscopy shows a fistulous opening on the lower third esophagus. (B) Chest CT shows an outpouching cavitary lesion, which had thin enhancing wall contiguous with mucosal layer of the esophagus (arrow) at the right side of the lower esophagus. (C) Chest CT with lung window settings shows patchy areas of ground glass opacities and bronchial dilataion with wall thickening, which represents inflammatory change due to chronic and recurrent infection in the superior segment of the right lower lobe. (D) Barium esophagography confirms the fistulous tract (arrowheads) between the lower third esophagus and the right lower lobar superior segmental bronchus. (E) Video-assisted thoracoscopic surgery (VATS) demonstrates the fistulous tract about 1cm in diameter (black arrow) between the esophagus (open arrow) and the lung (white arrow). (F) Follow-up barium esophagography after the fistula close operation. There is no evidence of contrast leakage or remnant fistula tract. (G, H) Follow-up CT checked at 3 months after the patient discharged from the hospital. Metallic staples (arrows in G) at the surgically closed site of lower esophagus are noted. In the lung window CT, previous noted inflammatory changes (C) in the right lower lobe of the lung is markedly improved.

Reference

1. Braimbridge MV, Keith HI. Oesophago-bronchial fistula in the adult. Thorax. 1965; 20:226–233.

2. Mangi AA, Gaissert HA, Wright CD, Allan JS, Wain JC, Grillo HC, et al. Benign broncho-esophageal fistula in the adult. Ann Thorac Surg. 2002; 73:911–915.

3. Griffo S, Stassano P, Iannelli G, Di Tommaso L, Cicalese M, Monaco M, et al. Benign bronchoesophageal fistula: Report of four cases. J Thorac Cardiovasc Surg. 2007; 133:1378–1379.

4. Rämö OJ, Salo JA, Mattila SP. Congenital bronchoesophageal fistula in the adult. Ann Thorac Surg. 1995; 59:887–889.

5. Kim JH, Park KH, Sung SW, Rho JR. Congenital bronchoesophageal fistulas in adult patients. Ann Thorac Surg. 1995; 60:151–155.

6. Deb S, Ali MB, Fonseca P. Congenital bronchoesophageal fistula in an adult. Chest. 1998; 114:1784–1786.

7. Kato H, Yoshikawa M, Saito T, Fukuchi M, Kato R, Kuwano H. Congenital bronchoesophageal fistula with Crohn's disease in an adult: report of a case. Surg Today. 2001; 31:446–449.

8. Lazopoulos G, Kotoulas C, Lioulias A. Congenital bronchoesophageal fistula in the adult. Eur J Cardiothorac Surg. 1999; 16:667–669.

9. Zach MS, Eber E. Adult outcome of congenital lower respiratory tract malformations. Thorax. 2001; 56:65–72.

10. Murdock A, Moorehead RJ, Tham TC. Closure of a benign bronchoesophageal fistula with endoscopic clips. Gastrointest Endosc. 2005; 62:635–638.