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Treatment of a broncho-esophageal fistula complicated by severe ARDS

  • E. TautzEmail author
  • D. Wagner
  • S. Wiesemann
  • A. Jonaszik
  • C. Bode
  • T. Wengenmayer
  • D. Staudacher
  • P. Biever
  • J. Hoeppner
  • D. Duerschmied
Case Report



Broncho-esophageal fistula formation is a rare complication of tuberculosis, most often seen in immunocompromised patients.

Methods and Results

In this paper, we report the case of a young non-immunocompromised refugee from Somalia diagnosed with open pulmonary tuberculosis complicated by extensive osseous involvement and a broncho-esophageal fistula with consecutive aspiration of gastric contents. The patient rapidly developed a severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (ECMO) therapy for nearly 2 months. The fistula was initially treated by standard antituberculous combination therapy and implantation of an esophageal and a bronchial stent. Long-term antibiotic treatment was instituted for pneumonia and mediastinitis. 7 months later, discontinuity resection of the esophagus was performed and the bronchial fistula covered by an intercostal muscle flap.


This case illustrates that tuberculosis should always be suspected in patients from high-incidence countries in case of lung involvement and that an interdisciplinary approach including long-term intensive care management can enable successful treatment of tuberculosis with severe, near-fatal complications.


Broncho-esophageal fistula Tuberculosis ARDS ECMO 



We greatly appreciate valuable contributions in clinical decision making and treatment of the patient by M. Elze, P. Hasselblatt, and H. Gölz.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

Treatment of the patient, preparation of the manuscript and discussion in the context of published literature comply with ethical standards and are in agreement with the Declaration of Helsinki.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical CenterUniversity of FreiburgFreiburgGermany
  2. 2.Department of Cardiology and Angiology I, Faculty of Medicine, Heart CenterUniversity of FreiburgFreiburgGermany
  3. 3.Department of Medicine II (Infectious Diseases), Medical CenterUniversity of FreiburgFreiburgGermany
  4. 4.Department of Thoracic Surgery, Medical CenterUniversity of FreiburgFreiburgGermany
  5. 5.Department of Radiology, Medical CenterUniversity of FreiburgFreiburgGermany
  6. 6.Department of General and Visceral Surgery, Medical CenterUniversity of FreiburgFreiburgGermany

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