Rare Gastrobronchial Fistula Mistaken for Aspiration Pneumonia in a Patient With Esophageal Cancer: A Case Report

Abstract

INTRODUCTION: Aspiration pneumonia in the setting of known esophageal cancer typically raises suspicion for dysphagia as the primary cause. Here, however, we present a rare case caused by a gastrobronchial fistula (GBF). This study was written according to the CARE case report guidelines [1]. CASE PRESENTATION: A 64 year old Caucasian female with stage IV esophageal cancer presented with acute nausea, vomiting and dyspnea. She had completed radiation and chemotherapy and underwent esophagogastrectomy with gastric pull through eight months prior. She presented with pulmonary sepsis and was treated with antibiotics. She then became acutely hypoxic and hypercapnic and required emergent intubation. An ETT cuff leak persisted despite radiographic confirmation of placement and appropriate cuff inflation. An urgent bronchoscopy showed bilious, projectile material in the RLL. An upper GI serieschallenging given the high volume of gastric refluxopacified the right mainstem bronchus below the carina. Concurrent bronchoscopy/endoscopy visualized a 1 cm gastric fistula at the surgical anastomosis without evidence of ulceration, infection or recurrent neoplasm, communicating with the posterior bronchus intermedius. Successful fistula closure was achieved with endoscopic OverStitch (TM).