Broncho‐mediastinal fistula following perforation of the oesophagus

Abstract

We present a 63-year old female with mediastinitis following an esophageal perforation, possibly favoured by an oesophageal motility-disorder and the use of non-steroidal anti-inflammatory drugs, who developed a broncho-mediastinal fistula in the left main bronchus. She was successfully treated with intravenous antibiotics, a cervical oesophagostomy and secondary isoperistaltic coloplasty.

Neonatal bronchomediastinal fistula

“…Neonatal bronchomediastinal fistulas are extremely rare and usually are associated with iatrogenic injury [1][2][3][4]. In this case, we suspect that the injury occurred after intubation and during endotracheal tube suctioning.…”

Spontaneous Pneumomediastinum and Subcutaneous Emphysema following Cocaine Inhalation and Ecstasy Ingestion

“…Previous reports have theorised that an oesophageal perforation secondary to barotrauma from vomiting (Boerhaave's syndrome) [3, 18] or even pill dysphagia (and resultant effects of corrosive additives) [2] may explain the presence of mediastinal and retropharyngeal free air. Conditions causing oesophageal dysmotility have been implicated secondarily contributing to increased intraoesophageal pressure [19]. A recent retrospective study identified up to ten percent of patients diagnosed with SPM had a proven oesophageal perforation found on endoscopy, in a contrast study, or discovered during surgery [20].…”

“…Referral to an otolaryngologist for flexible nasendoscopy (FNE) is recommended to look for pharyngeal perforation or injury, followed by a gastrografin swallow in the first 24 hours to assess for oesophageal injury. While extensive workup is not recommended in all cases [25], the combination of the chemical nature and mechanism of administration of the substances involved in drug-related SPM warrants thorough investigation in even the most stable patients [2, 11, 17–19, 23]. The only case in the literature requiring invasive intervention was that of pneumothorax in addition to pneumomediastinum [13], and the only reported case of recurrence of pneumomediastinum was that involving oesophagitis [22].…”

Thoracostomy tubes: A comprehensive review of complications and related topics

“…Patients with extensive pulmonary blebs also have a relative contraindication to TT placement because of the risk of bronchial fistula formation. [47] Elective or semi-elective TT placement should be avoided in patients with clinically significant coagulopathy and consideration should be given to normalization of coagulation parameters prior to commencing with the procedure.…”