Successful Surgical Closure of an Esophagobronchial Fistula Caused by a Foreign Body in the Esophagus of a Female Octogenarian with a Delayed Diagnosis: A Case Report

Abstract

Esophagobronchial fistula (EBF) caused by an esophageal foreign body is rare in adults. All surgical interventions in the reported cases were performed via right thoracotomy. We have successfully treated an 88-year-old woman with EBF caused by a thick 2 × 2 cm piece of cake decorating paper that was swallowed accidentally. There was a 2-month interval between ingestion of the foreign body and correct diagnosis. The bronchial opening of the EBF was on the cephalic wall of the proximal left main bronchus (LMB), so we planned a primary repair of the bronchial wall with sutures via left thoracotomy. We performed a division of the fistula and primary closure of the openings on the esophageal and bronchial walls and covered the suture sites with an intercostal muscle flap and pericardial fat, respectively. The patient resumed oral intake on postoperative day 11 and was subsequently transferred to other hospital for rehabilitation.

Keywords: esophageal foreign body; esophagobronchial fistula; pedicled flap; surgical repair; thoracotomy.

Fig. 1. (A) Upper endoscopy shows a foreign body lodged in the esophagus. The inset is a photograph of the foreign body, which was a piece of thick paper measuring 2 × 2 cm. (B) Upper endoscopy performed 1 week after removal of the foreign body shows a deep indentation. (C) X-ray fluoroscopy with contrast medium injected thorough an endoscopic channel shows a fistula connecting to the LMB. (D) A bronchoscopic image shows mucosal redness and edema on the left side of the wall of the lower trachea and stenotic change at the orifice of the LMB. (E) A close-up bronchoscopic image of the orifice of the LMB shows a deep indentation in the thickened bronchial wall. (F) An enhanced CT image shows luminal continuity between the LMB and the esophagus. (G) The reconstructed frontal plane on CT also shows luminal continuity between the LMB and esophagus. LMB: left main bronchus; RMB: right main bronchus; CT: computed tomography

Fig. 2. Intraoperative photographs showing (A) a view of the entire surgical field and (B and C) close-up views of the area indicated by the square in (A). (B) is a close-up image of the subaortic region showing that division of the fistula resulted in esophageal (indicated as an arrowhead) and bronchial (indicated as a dotted circle) wall defects. The inset in (B) is a sketch of the identical photograph. (C) shows the repaired esophageal wall (arrowhead) and bronchial wall (dotted line). (D) shows the pedicled pericardial fat (outlined arrowheads) and intercostal muscle flap (arrowheads) covering the sutured bronchial and esophageal sites, respectively.