Benign gastro-bronchial fistula – an uncommon complication of esophagectomy: case report

We report the case of a 56-year-old man who presented with features of repeated aspiration and chest infections six years following an esophagectomy for Barrett's esophagus. Despite extensive investigations the cause of symptoms was difficult to determine. The correct diagnosis of fistula from stomach to right main stem bronchus was made at bronchoscopy under general anesthesia. After ruling out local recurrence of cancer, a successful primary repair was carried out by resection of fistula and direct repair of gastric conduit and bronchus. He is well after 6 months of treatment.Late development of gastro-bronchial fistula is a rare complication of esophageal resection that may be difficult to diagnose.Surgical resection and direct closure is the treatment of choice, although the method of treatment should be tailored according to the anatomy of the fistula and the patient's condition.Gastrobronchial fistula (GBF) following esophagectomy for malignant disease is a recognized complication. However benign GBF are rare and the literature on this complication is limited consisting of a handful of case reports. Their mode of presentation and management are varied and there is no single treatment method, which is widely accepted. We report a case, which was successfully treated by direct primary repair. A brief review of literature is presented.A 67-year-old man with past history of Ivor Lewis esophagectomy 6 years previously for a Barrett's esophagus presented with dysphagia, recurrent cough, regurgitation and weight-loss. Endoscopy suggested a benign anastomotic stricture, for which he underwent dilatation. However his symptoms worsened and he continued to lose weight in spite of supervised dietary therapy. Aspiration was suspected and a barium swallow was performed. This demonstrated pharyngeal in-coordination, as the probable cause of aspiration. A repeat endoscopy was non-contributory. A feeding jejunostomy was inserted to prevent continued weight loss. In spite of th