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A case of surgery for congenital esophagobronchial fistula accompanied by a destroyed lung

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ABSTRACT

Congenital esophagobronchial fistula (EBF) is rarely seen in adults. We report a case of EBF detected in adulthood with a destroyed lung. A 67-year-old man experienced repeated pneumonia during his childhood. Since the age of 38, he had often suffered from bloody phlegm and always had a cough and sputum during oral intake. Before cardiac surgery for atrial fibrillation and valvular disease, computed tomography (CT) detected bronchiectasis, which could cause pulmonary bleeding during heart surgery, and the patient was introduced to our hospital for lung resection. A fistula between the esophagus and the right lower lung lobe was found using CT, esophagoscopy, and esophagography. Contrast CT and angiography revealed an abnormal artery branching from the inferior phrenic artery into the lobe. As indicated by intraoperative findings, the middle and lower lobes had strongly adhered to chest wall and diaphragm, but we located the fistula easily without adhesion to the surroundings, severed it using an automatic stapler, and resected the middle and lower lobes. The symptoms disappeared immediately, and the patient was uneventfully discharged.

The diagnosis of congenital EBF was established with intraoperative findings and pathological exam. The existence of pulmonary sequestration was suggested because of the long-term absence of any symptoms during his adulthood, the tract of the EBF running into the lung, not directly into the bronchus, and a septum pathologically detected in the right lower lobe. A congenital EBF should be considered for differential diagnosis in cases of limited bronchiectasis in elderly people.

No MeSH data available.


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Histopathological findings (×20, hematoxylin and eosin stain). a A photomicrographic image shows the fistula from the esophagus to the lung, not directly to the bronchus. The inner wall of the fistula (arrow) is covered with esophageal stratified squamous epithelium and bronchial epithelium. There is no evidence of inflammatory change. b This microscopic finding may show the septum between the ordinary lung and the sequestrated lung
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Fig4: Histopathological findings (×20, hematoxylin and eosin stain). a A photomicrographic image shows the fistula from the esophagus to the lung, not directly to the bronchus. The inner wall of the fistula (arrow) is covered with esophageal stratified squamous epithelium and bronchial epithelium. There is no evidence of inflammatory change. b This microscopic finding may show the septum between the ordinary lung and the sequestrated lung

Mentions: The diagnosis of congenital EBF to pulmonary sequestration was established with intraoperative and pathological findings (Fig. 4). The symptoms disappeared immediately following the operation, and the patient was discharged on the 12th day after surgery.Fig. 4


A case of surgery for congenital esophagobronchial fistula accompanied by a destroyed lung
Histopathological findings (×20, hematoxylin and eosin stain). a A photomicrographic image shows the fistula from the esophagus to the lung, not directly to the bronchus. The inner wall of the fistula (arrow) is covered with esophageal stratified squamous epithelium and bronchial epithelium. There is no evidence of inflammatory change. b This microscopic finding may show the septum between the ordinary lung and the sequestrated lung
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016486&req=5

Fig4: Histopathological findings (×20, hematoxylin and eosin stain). a A photomicrographic image shows the fistula from the esophagus to the lung, not directly to the bronchus. The inner wall of the fistula (arrow) is covered with esophageal stratified squamous epithelium and bronchial epithelium. There is no evidence of inflammatory change. b This microscopic finding may show the septum between the ordinary lung and the sequestrated lung
Mentions: The diagnosis of congenital EBF to pulmonary sequestration was established with intraoperative and pathological findings (Fig. 4). The symptoms disappeared immediately following the operation, and the patient was discharged on the 12th day after surgery.Fig. 4

View Article: PubMed Central - PubMed

ABSTRACT

Congenital esophagobronchial fistula (EBF) is rarely seen in adults. We report a case of EBF detected in adulthood with a destroyed lung. A 67-year-old man experienced repeated pneumonia during his childhood. Since the age of 38, he had often suffered from bloody phlegm and always had a cough and sputum during oral intake. Before cardiac surgery for atrial fibrillation and valvular disease, computed tomography (CT) detected bronchiectasis, which could cause pulmonary bleeding during heart surgery, and the patient was introduced to our hospital for lung resection. A fistula between the esophagus and the right lower lung lobe was found using CT, esophagoscopy, and esophagography. Contrast CT and angiography revealed an abnormal artery branching from the inferior phrenic artery into the lobe. As indicated by intraoperative findings, the middle and lower lobes had strongly adhered to chest wall and diaphragm, but we located the fistula easily without adhesion to the surroundings, severed it using an automatic stapler, and resected the middle and lower lobes. The symptoms disappeared immediately, and the patient was uneventfully discharged.

The diagnosis of congenital EBF was established with intraoperative findings and pathological exam. The existence of pulmonary sequestration was suggested because of the long-term absence of any symptoms during his adulthood, the tract of the EBF running into the lung, not directly into the bronchus, and a septum pathologically detected in the right lower lobe. A congenital EBF should be considered for differential diagnosis in cases of limited bronchiectasis in elderly people.

No MeSH data available.


Related in: MedlinePlus