Management of concomitant congenital tracheo-oesophageal fistula and cancer of the oesophago–gastric junction in an adult

Abstract

Congenital tracheo-oesophageal fistula in the adult is rare, and there have only been 16 such reported cases in the English literature. The concomitant presence of a cancer of the oesophago-gastric junction however has not been previously reported, and presents a treatment dilemma as to whether a staged or simultaneous surgical treatment should be performed. We report such a case that was successfully treated by staged surgical therapy.

Congenital tracheoesophageal fistula in an elderly patient with thoracic empyema

“…Conventional barium esophagography is considered the most sensitive test for diagnosing TEF. [2][3][4][5][6] Bronchoscopy and esophagoscopy are also useful for confi rming the orifi ce of a fi stula (Fig. 2A).…”

“…7 In the English literature, a summary of 21 cases revealed no sex preponderance and a relatively even distribution of ages from 15 to 79 years. [2][3][4][5][6] Generally, the criteria for the diagnosis of a congenital TEF in adults has the following features: (1) absence of past or present surrounding infl ammation or malignancy; (2) complete recovery after resection; and (3) the presence of normal mucosa and absence of adherent lymph nodes. 8 The present case was diagnosed as con- Esophagography after surgery revealed no leakage or stenosis.…”

“…In patients who have a congenital fi stula without esophageal atresia, (H-type fi stula), the symptoms are usually insidious and not severe; therefore, TEF is occasionally diagnosed after adolescence. [2][3][4][5][6] Only 21 adult cases of congenital TEF have so far been reported in the English literature. [2][3][4][5][6] This report presents a rare patient with TEF with empyema who underwent surgical treatment successfully.…”

Esophageal squamous cell carcinoma at the site of tracheo-esophageal fistula repair in a patient with cystic fibrosis

“…Although metaplasia is reported as one of the long-term complications after TEF repair, incidence of malignancy was reported to be lower than general population in a recent review of surgical outcomes 10. The concomitant presence of a TEF and esophageal carcinoma has been reported once and presents a treatment dilemma as to whether a staged or simultaneous surgical treatment should be performed 11. This case is unique as TEF, esophageal cancer (squamous cell) and CF have never been reported to the best of our knowledge.…”