Acquired Non-Malignant Esophago-Tracheobronchial Communications

¹ The Department of Surgery, Medical College of Virginia, Richmond, Virginia.

Seventy-five cases of acquired non-malignant esophago-tracheobronchial fistula have been reported in the literature during the past 32 years (1916 to 1949). Analysis of these cases has yielded valuable information.

The fistulas are classified on the basis of etiology. The known causes of fistula formation are infection, trauma and esophageal diverticula. There is a definite correlation between the type of trauma and the location of the fistulous opening in the tracheobronchial tree. Traction diverticula of the esophagus show a high incidence of communication with the secondary bronchi. The most common specific infections leading to fistula formation are tuberculosis and syphilis.

Development of a communication between the respiratory system and esophagus invariably leads to characteristic symptoms. Ingestion of fluids is followed by strangling or severe paroxysms of coughing after a momentary asymptomatic pause. Diagnosis is based upon history, physical examination, roentgenographic studies and endoscopic examinations.

Fistulas associated with active tuberculosis or syphilis should receive antibiotic therapy. Small fistulas and fistulas associated with exuberant granulation tissue should receive local cauterization and antibiotics in expectation of cure or alleviation of the local infection preparatory to later surgical treatment. Those complicated by bronchiectasis or lung abscess frequently require pulmonary resection in addition to closure of the esophageal defect.. Smooth epithelized communications unattended by suppurative disease of the lung are suitable for immediate and direct surgical closure.

Four cases of acquired non-malignant esophago-tracheobronchial fistula have been successfully treated by direct surgical closure. Six cases treated by this method have been reported in the literature during the past 32 years.