Benign broncho-esophageal fistula in the adult.
BACKGROUND
Benign broncho-esophageal fistula (BEF) in the adult is rare, and occurs as a complication of inflammatory disorders, foreign body ingestion, or congenital anomalies. Nonspecific symptoms lead to a delay in diagnosis.


METHODS
The charts of 13 patients from 1960 to 2001 at the Massachusetts General Hospital were retrospectively reviewed.


RESULTS
Nine patients had chronic cough, which worsened upon ingestion. Four patients developed BEF after prior thoracic surgery, and 3 after histoplasmosis. Silicosis, foreign body ingestion, lye ingestion, bronchogenic cyst, esophageal diverticulum, and a congenital anomaly caused BEF in 1 patient each. Barium swallow was the most useful diagnostic test. Fistulas most often arose from the right bronchial tree and communicated with the distal esophagus. Management involved excision of the tract, primary closure of the bronchus and esophagus, and interposition of vascularized tissue. There was one perioperative failure, but no long-term recurrences after successful surgical closure.


CONCLUSIONS
The majority of benign BEF in adults are acquired, and result from mediastinal inflammation. Accurate recognition and surgical closure prevents persistent uncontrolled aspiration and pulmonary sepsis.
Mangi
Abeel A
AA
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Gaissert
Henning A
HA
Wright
Cameron D
CD
Allan
James S
JS
Wain
John C
JC
Grillo
Hermes C
HC
Mathisen
Douglas J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001999:Bronchoscopy; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies