Broncho-oesophageal fistula due to idiopathic oesophageal ulceration in a patient with AIDS
Black, A.D.; Bizos, D.; Perovic, O.
South African Medical Journal 91(2): 116-117
2001
ISSN/ISBN: 0256-9574 PMID: 11288386 Document Number: 538279
Oesophageal disease in HIV-infected patients is common, with 30% of these patients having oesophageal involvement at some stage of their disease. Fistulous degeneration of oesophageal ulcers due to Mycobacteriurn tuberculosis, chronic irritation secondary to medications and aphthous ulceration have been well described. We report on a patient with oesophageal ulceration that subsequently developed an oesophagobronchial fistula. Extensive investigation for a malignant or infectious cause was negative. A Wall stent was inserted to occlude the fistula. Post-stenting, the fistula could still be visualized radiographically. After a trial of steroids and a feeding gastrostomy the fistula could no longer be demonstrated. We propose that idiopathic oesophageal ulceration can undergo fistulous degeneration, which may be reversed with a course of steroids and minimally invasive surgical procedures to bypass the fistula during the healing process. In this case delayed expansion of the Wall stent as the sole contributor to sealing the fistula cannot be excluded.