Abstract
A 49-year-old man was referred to our hospital for treatment of an esophagorespiratory fistula following 5-year airway stenting for stenosis of tracheal anastomosis. In consideration of the prior polysurgery and the patient’s poor general status and malnutrition, we selected multistep esophageal bypass combined with feeding enterostomy for nutritional support. Respiratory symptoms and pneumonia were rapidly improved by esophageal transection and decompression via a catheter esophagostomy. Nutritional status was also improved by enteral nutrition via a catheter gastrostomy. Four months after the esophageal transection, we conducted an esophageal bypass using an ileocolonic conduit because the right gastroepiploic artery had been used for omental reinforcement of tracheal anastomosis. The patient had no postoperative complications and was discharged 53 days after the bypass surgery. Multistep esophageal bypass including feeding enterostomy for perioperative nutritional management is a safe and useful alternative to direct closure for a critically ill patient with an esophagorespiratory fistula who is at high risk for operative mortality.
Similar content being viewed by others
References
Lolley DM, Ray JF, Ransdell HT, Razzuk MA, Urschel HC. Management of malignant esophagorespiratory fistula. Ann Thorac Surg 1978;25:516–520.
Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 2004;232:252–259.
Gerzic Z, Rakic S, Randjelovic T. Acquired benign esophagore-spiratory fistula: report of 16 consecutive cases. Ann Thorac Surg 1990;50:724–727.
Spalding AR, Burney DP, Richie RE. Acquired benign bronchoesophageal fistulas in the adult. Ann Thorac Surg 1979;28:378–383
Dumon JF. A dedicated tracheobronchial stent. Chest 1990;97:328–332.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 1982;5:649–655.
Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. J Parenter Enteral Nutr 1984;8:153–159.
Saito Y, Imamura H. Airway stenting. Surg Today 2005;35:265–270.
Morimoto Y, Tanaka Y, Itoh T, Yamamoto S, Kurihara Y, Nishikawa K. Esophagobronchial fistula in a patient with Behçet’s disease: report of a case. Surg Today 2005;35:671–676.
Shichinohe T, Okushiba S, Morikawa T, Kitashiro S, Manase H, Kawarada Y, et al. Salvage of a massive esophago-tracheal fistula resulting from a stenting treatment. Dis Esophagus 2006;19:299–304.
Koretz RL, Avenell A, Lipman TO, Braunschweig CL, Milne AC. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol 2007;102:412–429.
Radrizzani D, Bertolini G, Facchini R, Simini B, Bruzzone P, Zanforlin G, et al. Early enteral immunonutrition vs. parental nutrition in critically ill patients. Intensive Care Med 2006;32:1191–1198.
Greemberg L, Fisher A, Katz A. Novel use of neonatal cuffed tracheal tube to occlude tracheo-oesophageal fistula. Paediatr Anaesth 1999;9:339–341.
Seto Y, Yamada K, Fukuda T, Hosoi N, Takebayashi R, Chin K, et al. Esophageal bypass using a gastric tube and a cardiostomy for malignant esophagorespiratory fistula. Am J Surg 2007;193:792–793.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bamba, T., Kosugi, Si., Kanda, T. et al. Successful treatment for a benign esophagorespiratory fistula with perioperative nutritional management and multistep esophageal bypass operation: a case report. Esophagus 5, 93–97 (2008). https://doi.org/10.1007/s10388-008-0148-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-008-0148-x