Abstract
Most cases of esophagobronchial fistula in adults are found in malignant diseases. In the benign diseases, congenital esophagobronchial fistula, esophageal injury, diverticulum, tuberculosis, and lues are caused in the fistula. The purpose of this paper is to present a case with esophagobronchial fistula due to severe pulmonary silicosis, a 61-year-old male whose chief complain was coughing following the oral intake of food. An esophagobronchial fistula was diagnosed in the upper gastrointestinal series by his home doctor. He had a pulmonary silicosis anamnasis for over 20 years, and his chest radiograph showed severe egg-shell silicosic calcifications. Sinogram and bronchoscopy showed an esophagobronchial fistula from the middle thoracic esophagus to the left main bronchus. A surgical resection of the fistula was performed. During surgery, the fistula circumference was hard, and calcificated lymph nodes around infracarinal region were noted. The fistula, approximately 2cm wide and 0.5cm in thickness, was removed surgically with the surrounding connective tissue, and the stump was closed.
In a histopathological study of the fistula, the intraluminal mucosa of the fistula was surrounded with squamous epithelium, and a severe inflammatory cell invasion was found accompanying the calcification and anthracosis of the lymph nodes. From the histological findings, we concluded that a pulmonary silicosis with severe inflammation was the main cause of the fistulation.
