Congenital oesophago-bronchial fistula with diverticulum in the adult
Yajima, K.; Doi, O.; Nabeshima, H.; Okamoto, N.; Terazawa, T.; Tateishi, R.
Nihon Kyobu Geka Gakkai 28(12): 1874-1881
1980
ISSN/ISBN: 0369-4739 PMID: 6780637 Document Number: 157760
The clinical details of a 51 yr old woman with congenital broncho-esophageal fistula is reported. The lesion, especially with esophageal diverticulum (Braimbridge type I) is very rare and only 4 cases are found in the literature in Japan. She had a persistent cough attack especially after acid meals since childhood. A chest X-ray film showed chronic bronchitis in the right lower field. Cine-esophagogram revealed a fistula between the esophagus and the right lower lobe bronchus with mild aspiration in the right bronchial trees. Esophagoscopic and bronchoscopic examinations demonstrated the presence of a fistulous opening at the right wall of middle esophagus and at the bifurcation between right B6a and B6b+c. Right thoracotomy and removal of the fistulous tract was performed. Neither adhesion nor enlargement of lymph-nodes were found in the surrounding tissues. The patient is in good health after operation. Histological observations of the resected fistula showed no chronic inflammatory changes such as fibrosis, though muscular layers and transitional zone between squamous epithelium and bronchial epithelium were present. Referring to past literature, discussions on the differential diagnosis between the congenital and acquired types, on pathogenesis of the congenital type, and on the reason why symptoms become apparent after adolescence, were made. The 1st choice of therapy is a resection of the fistula with antibiotic chemotherapy of the remaining infected lung lesion. The resection of infected lung should be carefully considered.