Abstract
We report a 27-year-old patient with an esophagobronchial fistula (EBF) that developed at balloon dilatation for secondary esophageal stenosis.
The male patient, who had the 5p- syndrome and mental retardation, was referred to our institution because of difficulty in swallowing and anemia. Fluoroscopy and esophageal endoscopy revealed severe stenosis of the mid-esophagus.
Fundoplication with gastrostomy was successfully performed. Dilation for the stenosis was performed using a balloon dilator 4 weeks after the operation, followed by transient improvement. Biopsy specimens from the lower esophagus histologically demonstrated Barrett esophagus. A 24-hour pH-monitoring test demonstrated no pathologic gastroesophageal reflux.
After a fourth bougienage, his coughs deteriorated and EBF was diagnosed by esophagraphy. Stent placement to the esophageal stenosis was undertaken, followed by conservative therapy, which improved his respiratory symptoms temporarily.
However, 6 months later, we elected to perform total gastroesophageal dissociation because the fistula had recurred. After resection of the mid-lower esophagus with closure of the EBF by the use of the surrounding esophageal wall, the esophago gastric junction was dissected and an esophago jejunostomy was carried out in Roux-en-Y fashion in the thoracic cavity.
His postoperative course was uneventful except for minor anastomotic leakage, which recovered spontaneously with conservative treatment.
Five years after the operation, he is doing well.
