Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula

Abstract

Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.

Keywords: Bronchial fistula; Bronchoesophageal fistula; Esophageal duplication; Esophageal fistula.

Fig. 1.

(A) Initial upper gastrointestinal endoscopy image showing an opening (arrow) in the mid-esophagus. (B) Esophagography image taken at another hospital showing a bronchoesophageal fistula (arrows) between the mid-esophagus (arrowheads) and the lower left bronchus.

Fig. 2.

Follow-up esophagography. Suspicious contrast leakage at the left side of the mid-esophagus and drainage to the distal esophagus are evident (arrow).

Fig. 3.

Follow-up upper gastrointestinal endoscopy. (A) At the mid-esophagus, the proximal opening of the esophageal duplication (ED) is seen (arrow). The location of the proximal opening is different from the previously examined area. (B) Distal opening of the ED at the cardia in the hiatal hernia sac (arrow).

Fig. 4.

Chest computed tomography scan showing an about 7-mm air-filled tract (arrows). (A) Axial section view. (B) Coronal section view.

Fig. 5.

Schematic diagram of the patient's pathological anatomy.