Surgical repair of esophagobronchial fistula caused by radiation injury.
We present an unusual case of a benign esophagobronchial fistula caused by radiotherapy to treat esophageal carcinoma which was closed successfully. A 62-year-old man with superficial squamous cell carcinoma of the esophagus underwent radiotherapy, including 60 Gy externally and 10 Gy intraluminally from January to March 1995. Esophagography revealed a fistula between the esophagus and left main stem bronchus on January 14, 1996. No residual cancer existed. Neither stenting with a silicone tube nor with a covered flexible metallic stent occluded the fistula. Thoracic esophagectomy, closure of the esophagobronchial fistula using a 2-cm nubbin of esophageal wall, surrounding the orifice of the fistula and antesternal gastric pull-through reconstruction with mediastinal lymphadenectomy were performed. The postoperative course was uneventful and there is no evidence of recurrence of the fistula or the cancer 5 years postoperatively. Radiotherapy may cause esophagobronchial fistula even in cases of superficial esophageal cancer. Bypass surgery should be considered because stenting is not effective for benign fistula without stricture.
Fukuhara
Kenichiro
K
Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. fuku@eva.hi-ho.ne.jp
Osugi
Harushi
H
Tokuhara
Taigo
T
Takada
Nobuyasu
N
Takemura
Masashi
M
Lee
Shigeru
S
Ueno
Masakatsu
M
Tanaka
Yoshinori
Y
Fujiwara
Yushi
Y
Nishizawa
Satoshi
S
Hashimoto
Yukie
Y
Kinoshita
Hiroaki
H
D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects