Therapeutical solutions for non-malignant eso-bronchial fistulas

Abstract

We assessed the efficacy of surgical treatment for the patients with eso-respiratory fistulas. The following cases revealed the anesthesic and surgical difficulties, and also intraoperative and postoperative complications that can occur when the esophageal contents get into the respiratory system. In these situations, therapy must be adapted according to fistula's topography and etiology, and also to patients' biological conditions.

Fig. 1

Preoperative X-ray exam - lung opacity at upper right lobe

Fig. 2

Preoperative thoracic CT scan upper right lobe suppuration

Fig. 3

Bronchoscopy – bronchial fistula

Fig. 4

Intraoperative aspects: A – upper right lobbectomy; B – dissection of esophagus and exposure of fistula; C – esophageal myotomy

Fig. 5

Postoperative chest X-ray – complete reexpansion of the right lung

Fig. 6

Preoperative esophagography – round esophageal opacity

Fig. 7

Esophageal barium passage: A - left eso-bronchial fistula; B - partial esophageal stenosis with dilatation

Fig. 8

Thoracic CT scan: A - left lower lobe pneumonia; B – left eso-bronchial fistula

Fig. 9

Postoperative chest X-ray: right lung ARDS

Fig. 10

Postoperative bronchoscopy at 2 months after surgery – intermittent stenosis of left main bronchus

Fig. 11

Esophageal barium passage – normal

Fig. 12

Chest X ray after re-thoracotomy

Fig. 13

Postoperative thoracic scans

Fig. 14

Bronchoscopy after re-thoracotomy - normal aspects

Fig. 15

Preoperative CT scan – revealed the eso-tracheal fistula

Fig. 16

Intraoperative aspects: A - dissection of esophagus and trachea, revealing the fistula; B - muscle interposition between esophagus and trachea after resection of fistula