An esophagobronchopleural fistula successfully treated by a surgical procedure combined with conservative therapy after resection for lung cancer.
The patient was a 43-year-old woman, who had undergone a right middle and lower lobectomy for adenocarcinoma of the lung. An esophagobronchopleural fistula developed two months after the operation. It was treated by a combined procedure consisting of pedicle flap closure of the fistula and thoracoplasty. The esophagobronchopleural fistula recurred two days later, however, and another pedicle flap closure with fenestration of the chest wall were performed in a third operation. A bronchopleural fistula then recurred, after which it was treated by conservative therapy including intravenous hyperalimentation, frequent dressing changes and systemic administration of appropriate antibiotics. It closed spontaneously 23 days after surgery, in spite of this being a very rare but serious complication very difficult to treat and cure. From our experience with this particular case, we recommend, for treating esophagobronchopleural fistulas, proper drainage, antibiotic therapy, intravenous hyperalimentation and packing of the empyema space, together with closure of the fistula using a muscle or pleural flap.
Sano
T
T
Department of Surgery, National Cancer Center Hospital, Tokyo.
Naruke
T
T
Watanabe
H
H
Kondo
H
H
Goya
T
T
Tsuchiya
R
R
Suemasu
K
K
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D001983:Bronchial Fistula / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D004937:Esophageal Fistula / Q000209:etiology / Q000628:therapy*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D010995:Pleural Diseases / Q000209:etiology / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects*; D012086:Reoperation; D013524:Surgical Flaps; D013905:Thoracoplasty