Benign gastrobronchial fistula following oesophagectomy in a patient presenting with respiratory failure

Abstract

Benign gastrobronchial fistula (GBF) is a rare but potentially life-threatening complication of oesophagectomy for malignancy. We present a case of GBF post Ivor-Lewis surgery manifesting as pulmonary sepsis and type II respiratory failure. Clues to the diagnosis were persistent hypercapnia despite high minute ventilation, aspiration of gastric content through the endotracheal tube and accumulation of air in the nasogastric drainage bag. Flexible bronchoscopy confirmed the diagnosis. Surgical exploration identified necrosis of the proximal stomach as causative factor. Despite reconstruction of the oesophagogastric anastomosis and interposition of an intercostal muscle flap, the patient developed a new episode of type II respiratory failure. Bronchoscopy revealed in situ recurrence of the fistula. Patency of the fistula was proven through application of methylene blue with subsequent gastroscopy. A conservative, symptom-based, management was conducted. The patient died 6 hours later.

Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study

“… 22 , 23 , 24 , 32 Similarly, for bronchial NEAF, using a perforator flap provides tension-free posterior-wall closure and material-free airway repair, thereby minimizing the risk of subsequent bronchomalacia and stenosis. 33 In our 3 patients with bronchial fistulas, perforator flap reconstruction produced airtight wall closure with a skin-based rigid structure capable of resisting damage from digestive-tract secretions. In addition, perforator flaps offer the versatility and plasticity needed to reach any fistula site, and they also fill the mediastinal space with no risk of airway or gastric conduit compression.…”