Early complications. Esophagopleural fistula

Esophagopleural fistulae complicate the outcome of approximately 0.5% of pneumonectomies, regardless of whether performed for benign or malignant conditions. Early postoperative fistulae result from operative injury to the esophagus: both direct tears of the mucosa and devascularization with secondary necrosis have been documented. Late esophagopleural fistulae, diagnosed beyond the third postoperative month, are due to cancer recurrence or various inflammatory disorders. The usual presentation is empyema thoracis. Diagnosis is suggested by drainage of food particles or saliva, and the presence of yeast cells within the pleural fluid. Confirmation relies on direct opacification of the fistulous tract during opaque swallow studies. Treatment is initiated by clearance of empyema with either tube thoracostomy or Clagett window, and feeding gastrostomy or jejunostomy.