Broncho-esophageal fistula (BEF) is an abnormal communication between the food pipe and the wind pipe. Cancer, trauma, and infections are the most common causes of broncho-esophageal fistula. The main cancerous causes include esophageal or lung cancer.
Tuberculosis, histoplasmosis, and actinomycosis are the most common infectious causes. Because the esophagus and left main bronchus lie closely one above each other, both esophageal and tracheobronchial cancers may result in BEF.
BEF is encountered in 5% to 15% of patients with esophageal cancer and is a sign of poor prognosis. The most common symptoms are chronic and paroxysmal cough, dysphagia, and fever. In patients with a BEF, oral intake is restricted because of aspiration and paroxysmal coughing. Eventually, malnutrition develops, which further leads to recurrent pulmonary infections, bronchopneumonia, and sepsis. Therefore, management of the BEF is often more important than treatment of the underlying cancer.
The treatment of BEF depends on the severity of symptoms, the location of the fistula, and the general condition of the patient. Placements of self-expanding metallic stents, silicon esophageal prostheses, percutaneous gastrostomy, or surgical esophageal bypass are among the various palliative and conservative treatment modalities.
Conventional silicon prostheses are associated with complications in approximately 15% to 40% of patients. It has been shown that metallic stents are superior to other methods. Closure of the fistula could be considered after appropriate treatment for the underlying malignancy. In our case, the fistula was too large to be treated conservatively; thus, the patient was referred for surgery.
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