Double-Lumen Esophagus: Formation of a New Lumen or Septation of the Existing One?

Double lumen esophagus: A rare complication of gastroesophageal reflux disease

“…Esophageal ulcers that have perforated into the mediastinum or penetrated the airway, resulting in esophagotracheal, esophagobronchial, or esophagopericardial fistula, have been reported in the literature . To our knowledge, only 11 cases of esophagogastric fistula have been reported in the past …”

“…The suppression of acid production likely aids in healing of the inflamed tissue. As esophagogastric fistula tends to develop in patients who already have a history of repeated manipulations of the esophagus, these patients are generally not good surgical candidates . Follow‐up surveillance by endoscopy and management of symptoms may be a reasonable approach in these patients.…”

“…Esophagogastric fistula has also been reported in cases of esophageal cancer and Crohn's disease . In our literature review, almost half of the reported patients with esophagogastric fistula had a history of Nissen fundoplication . Esophageal dilation procedures done for strictures were also found to be a predisposing factor for esophagogastric fistula, as two patients described in the literature had a history of esophageal dilation .…”

“…It appears that there is no specific circumferential location of fistula formation in the esophagus. Choudhry and Shenoy reported anterior and posterior locations in their two cases . It is postulated that surgically induced ischemia, microscopic perforations and necrosis from repeated manipulation of the esophagus leads to scarring and poor vascularity of the distal esophagus.…”

“…Endothelial necrosis from esophagitis leads to penetration of the muscularis mucosae and finally to adjacent structures. It triggers formation of granulation tissue and fibrosis, eventually leading to a fistulous tract . The exact mechanism of the formation of a fistula is still understudied due to the rarity of this disease process.…”