Treatment of a broncho-esophageal fistula complicated by severe ARDS
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.
KeywordsBroncho-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.
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.
- 8.Liao LY, Wu H, Zhang NF, et al. Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis: a case report and review of the literature. Chin J Tubere Respir Dis. 2013;36(11):829–32.Google Scholar