V-129 Three-stage management of a complex bronchoesophageal fistula in a young patient with disseminated tuberculosis

Hintergrund

Acquired fistulas between the central airways and the esophagus are rare and mostly due to esophageal or lung cancer (50%). The most common cause of nonmalignant fistulae is mechanical ventilation, other causes include trauma, tracheal or esophageal surgery und granulomatous mediastinal infections. Tracheoesophageal fistula due to tuberculosis are particularly challenging and require an orchestrated, interdisciplinary, and often staged approach.

Material und Methode

We present a case of a 29-year-old male with disseminated tuberculosis. Shortly after the initiation of the anti-tuberculotic treatment the patient developed ARDS with severe respiratory failure. The patient was intubated, and a Veno-venous extracorporeal membrane oxygenation (ECMO) established. The CT showed diffuse pulmonary opacification. The esophagoscopy and bronchoscopy revealed multiple ulcers in esophagus with a fistula between the esophagus and left main bronchus.

Ergebnis

Initial treatment of the fistula consisted of double stenting (esophagus and left main bronchus); hereafter the patient could be weaned off ECMO after a total of 50 days. After recovery of respiratory function, the patient was subjected to a right thoracotomy with primary closure of the bronchial fistula by direct suture, reinforcement with an intercostal muscle flap and esophageal resection with cervical diversion. Reversal of the discontinuity with Gastric pull-up reconstruction was finally performed five months later. The follow up Bronchoscopy and barium swallow test showed complete healing of the bronchial fistula with normal postoperative function of the neoesophagus.

Schlussfolgerung

Bronchoesophageal Fistula (BEF) remains a high risk and technically challenging condition. This report emphasizes the significance of a multidisciplinary management of this complicated case of (BEF) due to disseminated tuberculosis, including bridging with ECMO, double stenting and surgical reconstruction, which lead to successful treatment of this rare life-threatening condition.

Publication History

Article published online:
06 September 2021