Abstract
Congenital esophago-bronchial fistula in the adult is not often seen. Moreover appearance as a congenital disease with an esophageal diverticulum (Braimbridge type I) is very rare and only 8 cases are reported in Japan. We have recently treated such a rare case.
A 32-year-old female had been complaining of dysphagia for 7 years. For 5 of these years she had a cough and fever once a month. About 6 months before admission she had paroxysmal coughing following fluid ingestion. Her chest roentgenogram showed a silhouette sign on the right heart border and an infiltrative shadow in the right S10. Her bronchogram and esophagogram revealed a fistulous tract between the midesophagus and right B10. On bronchoscopy and esophagoscopy, the orifices of the fistula in the bronchus and in the esophagus were seen clearly. On fiberoptic bronchoscopy the bronchial membrane around the orifice of the fistula did not show any malignant findings, only inflammatory findings such as edema and redness. Esophagoscopy showed a diverticulum on the right wall of esophagus 32cm from the incisors, and there was a round fistular orifice at the bottom of the diverticulum without malignant or inflammatory findings.
Right thoracotomy and resection of the fistulous tract and the diverticulum was performed. Neither adhesion nor enlargement of lymph nodes was found in the surrounding tissues. The patient has been in good condition since.
Histological examination of the resected fistula showed no chronic inflammatory changes such as fibrosis, and showed muscular layers and a transitional zone between the stratified squamous epithelium of esophagus and the ciliated columnar epithelium of bronchus.
We reviewed the literature, and discussed differential diagnosis between the congenital and acquired types of esophago-bronchial fistula.
