Management of esophagopulmonary fistula after gunshot – case report and literature review

Abstract

Introduction: An esophagorespiratory fistula is a pathological communication between the esophagus and respiratory tract. The most common type is a communication with the trachea, while the least common is with lung parenchyma. These fistulas are classified as congenital or acquired while etiology is benign or malignant. Aim: We present a case report of a patient who developed esophagopulmonary fistula several years after gunshot in the right side of the chest. Additionally, we discuss the treatment methods and compare the outcomes with other case studies and analyses from world literature. Case study: A 48-year-old male patient was admitted to the Department of Thoracic Surgery and Transplantation due to bleeding from the respiratory tract. Radiological images revealed a fistula between the esophagus and right lung parenchyma. Furthermore, bronchiectasis in the right lung was found. Tissues of the fistula, right middle and lower lobes were resected. The patient required renewed hospitalization due to pleural empyema. Furthermore, recurrence of the fistula was observed. Results and discussion: Treatment of esophagorespiratory fistula depends on the etiology and location of the pathological communication. Surgery provides the best possible outcomes in patients with a benign fistula. Proximal location requires cervicotomy, while distal location a thoracotomy. In addition, a distal fistula may damage lung parenchyma. Conclusions: A long-term distal fistula may require pulmonary resection, but early diagnosis would help to avoid more invasive procedures. As symptoms are non-specific and benign etiology is not frequent, thorough examination in search of malignancy is required.