Congenital tracheoesophageal fistula in an elderly patient with thoracic empyema

Yasuda, Manabu; Hanagiri, Takeshi; Ichiki, Yoshinobu; Takenoyama, Mitsuhiro; Sugio, Kenji; Yasumoto, Kosei

doi:10.1007/s11748-009-0450-0

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…The CT findings of adult EAF have been previously described only in case reports (11)(12)(13)(14)(17)(18)(19)(20)(21). A small series of 10 congenital fistulas in neonates with esophageal atresia showed a good correlation between CT and surgical findings (22).…”

Section: Discussionmentioning

confidence: 99%

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Direct and indirect CT imaging features of esophago-airway fistula in adults

Little

Mendoza

et al. 2020

J Thorac Dis

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Background: Esophago-airway fistula (EAF) is an abnormal connection between the esophagus and the trachea or a major bronchus. While contrast esophagography remains the primary radiographic tool for the diagnosis of EAF, computed tomography (CT) is often employed in its evaluation. A systematic analysis of CT findings of EAF in adults has not been previously published. The goal of our study is to determine the direct and indirect CT findings of EAF in adults. Methods:We identified patients with EAF detected on CT at our institution between January 1, 2001 and December 31, 2019, with endoscopic or surgical confirmation. We collected patient clinicopathologic characteristics and assessed CTs for direct and indirect imaging features of EAF in these patients. Results: Twenty-six patients (median age: 56 years; range, 25-79 years; F=13, 50% and M=13, 50%) with confirmed EAF were identified. Half of the patients had an underlying malignancy. On CT, a direct connection between the esophagus and the airway was identified in most cases (22/26; 85%). Common indirect CT findings of EAF included esophageal wall thickening (21/26, 81%), mediastinal fatty stranding (21/26, 81%), airway wall thickening (20/26, 77%), fluid or debris within the airways (17/26, 65%), and focal or diffuse esophageal dilation with air (17/26, 65%). Mediastinal fluid collections were infrequently seen (4/26, 15%), but findings of aspiration or other pneumonia were common (19/26, 73%).Conclusions: CT plays an essential role in both the primary and secondary evaluation of adult EAF resulting from both malignant and benign etiologies. CT may be the first diagnostic exam to suggest and detect the presence of EAF and may precede clinical suspicion, and it can detect a subset of fistulas not demonstrated on esophagography. There are several direct and indirect imaging findings on CT that can help in the detection of EAF.

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Section: Discussionmentioning

confidence: 99%

“…Benign conditions such as prolonged intubation, trauma (both iatrogenic and non-iatrogenic), and infections are other less common causes of acquired EAF (1,(5)(6)(7)(8)(9). Even less frequent are small congenital TEFs that are diagnosed or recur late in adulthood (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Direct and indirect CT imaging features of esophago-airway fistula in adults

Little

Mendoza

et al. 2020

J Thorac Dis

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“…The Grosstype E (i.e. H-type fistula), without accompanying esophageal atresia, is a rare anomaly (4.2% in congenital TEF) which is usually diagnosed in adults [1,2].…”

Section: Introductionmentioning

confidence: 99%

Management of acquired benign tracheoesophageal fistula in adults: a twelve-year experience

Šileika¹,

Jovaišas²,

Jagelavičius³

et al. 2013

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Background / ObjectivesAcquired nonmalignant tracheoesophageal fistula (TEF) in adult patients develops in a variety of conditions, the predominant being postintubation. Several management options have been suggested, while the optimal strategy remains controversial.The aim of this review is to present our clinical experience and to find the optimal management for TEF.MethodsThis study is a retrospective review of all patients who underwent management for benign TEF at the Vilnius University Hospital between January 2000 and December 2012.ResultsSeven patients (three female and four male) with a benign TEF were referred to the Department of General Thoracic Surgery of the Vilnius University Hospital from January 2000 to December 2012. Their mean age was 48.3 ± 11.4 years. PostintubationTEF accounted for six fistulas (85.7%), while one patient (14.3%) suffered from injury during percutaneous dilational tracheostomy. Five patients underwent TEF closure (71.4%). Four patients underwent a simple repair of the fistula, while one patient required tracheal resection and reconstruction. Endoscopic management with tracheal dilation and T tube placement was performed to one (14.3%) and additional jejunostomy was done also to one patient (14.3%). Four patients (57.1%) hadpostoperative complications. Two postoperative deaths occurred (28.6%).ConclusionsSingle-stage surgical repair with or without tracheal resection and reconstruction can be successfully performed after the weaning from mechanical ventilation in patients with acquired nonmalignant TEF.Key words: tracheoesophageal fistula, surgical closure, tracheal resection, nonmalignant fistulaĮgytos tracheoezofaginės jungties gydymas: dvylikos metų patirtis Įvadas / tikslasĮgytos nenavikinės kilmės tracheoezofaginės jungties (TEJ) priežastys yra įvairios, dažniausia iš jų – pointubacinė. Yra pasiūlyta keletas gydymo metodų, tačiau dėl geriausios gydymo taktikos vis dar diskutuojama. Šios apžvalgos tikslas – išnagrinėtimūsų klinikinę patirtį ir rasti optimalų gydymą tų ligonių, kuriems nustatyta TEJ.MetodaiRetrospektyviai išanalizuoti ligoniai, kurie 2000–2012 m. buvo chirurginiu būdu gydomi Vilniaus universiteto ligoninės Krūtinės chirugijos skyriuje. Rezultatai2000–2012 m. nuo nenavikinės kilmės TEJ gydyti 7 ligoniai (3 moterys ir 4 vyrai), kurių amžiaus vidurkis buvo 48,3±11,4 metų. Pointubacinė TEJ nustatyta šešiems ligoniams (85,7 %), vienam ligoniui (14,3 %) TEJ atsirado po perkutaninės dilatacinės tracheostomijos. Penki ligoniai gydyti chirurginiu būdu (keturiems ligoniams trachėja atskirta nuo stemplės, o jų sienų defektai užsiūti; vienam ligoniui papildomai atlikta trachėjos rezekcija ir rekontstrukcija). Endoskopinis trachėjos spindžio plėtimas ir stentavimas T formos endoprotezu taikytas vienam ligoniui (14,3 %); maitinimui skirta jejunostoma atlikta taip pat vienam ligoniui (14,3 %). Keturiems ligoniams pasitaikė pooperacinių komplikacijų (57,1 %). Po gydymo mirė du ligoniai.IšvadaVienmomentė TEJ šalinimo operacija su trachėjos rezekcija ir rekonstrukcija arba be jos gali būti sėkmingai atlikta savaime kvėpuojantiems ligoniams, kuriems yra nenavikinės kilmės TEJ.Reikšminiai žodžiai: tracheoezofaginė jungtis, trachėjos rezekcija, nenavikinės kilmės jungtis.

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“…Generally, adults have acquired tracheoesophageal/bronchoesophageal fistulas, because it is rare for a congenital fistula to remain asymptomatic until adulthood. 1 The most common etiology of benign acquired fistula is trauma, a cuffrelated tracheal injury, or stent-induced complications of the treatment of benign esophageal stenosis. 2,3 The development of a fistula due to malignancy is mainly caused by locally advanced esophageal cancer or lung cancer.…”

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confidence: 99%

Esophageal Bypass Using a Gastric Tube for a Malignant Tracheoesophageal/Bronchoesophageal Fistula: A Report of 4 Cases

Hanagiri

Morita

Shigematsu

et al. 2011

International Surgery

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Tracheoesophageal/bronchoesophageal fistulas are often caused by locally advanced esophageal cancer and lung cancer, and result in life-threatening conditions such as severe cough and dyspnea due to pneumonia. We herein report the clinical characteristics of 4 patients with tracheoesophageal/bronchoesophageal fistulas. All patients were men, and ranged in age from 40–69 years. Three patients had esophageal cancer and 1 had lung cancer. All 4 underwent esophageal bypass using a gastric tube with tube drainage of the distal side of the esophagus. Three patients died at 3, 4, and 5 months after surgery. However, these patients were allowed to enjoy food orally up until the last few days of life. One patient who underwent esophageal bypass and chemoradiotherapy has remained well for 5 years without any evidence of recurrence. This bypass procedure is therefore considered to be a feasible treatment choice for patients with tracheoesophageal/bronchoesophageal fistulas.

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Congenital tracheoesophageal fistula in an elderly patient with thoracic empyema

Cited by 5 publications

References 7 publications

Direct and indirect CT imaging features of esophago-airway fistula in adults

Direct and indirect CT imaging features of esophago-airway fistula in adults

Management of acquired benign tracheoesophageal fistula in adults: a twelve-year experience

Esophageal Bypass Using a Gastric Tube for a Malignant Tracheoesophageal/Bronchoesophageal Fistula: A Report of 4 Cases

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