Colobronchial Fistula: A Rare Complication of Crohr's Colitis

Abstract

A 29-yr-old white woman presented with chronic pneumonia in the left lower lobe and with left pleural effusion. She was known to have inflammatory bowel disease, but she was asymptomatic under maintenance treatment with 5-ASA. She received numerous antibiotic regimens according to susceptibility testing of microorganisms cultured from sputum and bronchial lavage and on an empiric basis was also given antituberculosis treatment, but there was no clinical improvement or change in the chest radiographic findings. Sputum was repeatedly examined and yielded, among other organisms, Clostridium inocuum, Enterobacter, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus. On one microscopic examination of sputum, the presence of feculent material was suspected. A subsequent gastrografin enema revealed a cologastric and colobronchial fistula between the splenic flexture of the colon and the greater curve of the stomach and the bronchial system. Segmental resection of the colon and resection of the lower lobe of the left lung were performed. Histologic findings of the resected colon were consistent with Crohn's disease. After a long period of postoperative recovery, the patient returned to good general health and well-being. To our knowledge, a colobronchial fistula caused by Crohn's colitis has not been previously reported.

Colobronchial fistula: the pathogenesis, clinical presentations, diagnosis and treatment

“…Based on the anatomical location of fistula and different causes, all the CBF cases were classified into four different types. Type I, CBF secondary to the adhesion among colon, diaphragm and lung (20 cases) (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)29): both the colon and lung directly adhere to diaphragm and the fistula forms between colon and lung through diaphragm; type II, CBF secondary to diaphragmatic hernia (8 cases) (2,3,17,18,23,24): the colon goes through diaphragm to form diaphragmatic hernia, directly adheres to lung tissue and forms fistula; type III, CBF secondary to sub diaphragmatic abscess or empyema (7 cases) (4,5,(25)(26)(27)(28)30): the colon and lung tissue fistula connect indirectly through the sub diaphragmatic or pleural abscess; type VI, CBF secondary to colon interposition (2 cases, Figure 2) (31,32).…”

“…For type IV, all 2 cases accepted colonic interposition ( Table 1). There were 30 cases (2,4,(6)(7)(8)(9)(10)(12)(13)(14)16,17,(19)(20)(21)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) with the left side fistula and 7 cases (1,3,5,11,15,18,22) with the right side fistula.…”

Respiratory System Involvement in Inflammatory Bowel Diseases

“…There are several reports on oesophagobronchial [81][82][83], colobronchial (splenic flexure area) [84][85][86][87][88], and ileobronchial [89] fistulae. Clinical and radiological presentation was that of pneumonia, typically with pleural effusion and anaerobic flora on sputum culture.…”

“…Surgical treatment was usually necessary. Pulmonary fistulae should be always considered in patients with CD and difficult to treat pneumonia [81][82][83][84][85][86][87][88].…”

Pulmonary involvement of inflammatory bowel disease

“…The pathophysiology of fistulous tract development in Crohn's disease is yet unknown (49). Colobronchial fistulas have been quite frequently described in Crohn's disease, in most cases between splenic flexure of colon and left bronchial tree and in one case between splenic flexure of colon, stomach and left bronchial tree (50)(51)(52)(53). Recurrent pneumonia with feculent sputum in patients with Crohn's disease should raise suspicion of colobronchial fistula (49).…”