Congenital bronchoesophageal fistula in the adult

Abstract

We describe a case of bronchoesophageal fistula in a 58-year-old woman, who did not show the usual symptom of coughing after ingestion. Bloody sputum and hemoptysis had appeared at the age of 46, and repeated bouts of left-sided pneumonia had occurred from age 53. In June 2000, she was admitted with bilateral pneumonia. After antibiotic therapy, chest X-ray films, computed tomography of the chest, and pulmonary blood flow scintigraphy showed destruction of the left lower lung lobe. Surgery was carried out in July 2000. Because air transudation from the oral cavity continued after the start of mechanical ventilation, communication between the airway and the digestive tract was suspected. After left lower lobectomy, the esophageal surroundings were found to be desquamated, and a bronchoesophageal fistula connecting the esophagus with the left main bronchus was revealed. Because the fistula was short, it was transected and closed by suture and ligation. Intraoperative esophageal endoscopy showed that the fistula had no inflammatory changes in the mucosal surface. The patient's postoperative course was good. Coughing after ingestion is a characteristic symptom of bronchoesophageal fistula. Because this patient had not reported this symptom, preoperative diagnosis of the bronchoesophageal fistula was difficult.