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Early complications. Esophagopleural fistula
1Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, France. Gilbert.Massard@chru-strasbourg.fr
Chest Surgery Clinics of North America
|August 25, 1999
Summary
Esophagopleural fistulae, a rare complication after pneumonectomy, can arise from surgical injury or late recurrence. Diagnosis involves identifying food or saliva in pleural fluid, confirmed by imaging, with initial treatment focusing on empyema and nutritional support.
Area of Science:
- Thoracic Surgery
- Gastroenterology
- Pulmonary Medicine
Background:
- Esophagopleural fistulae (EPF) complicate approximately 0.5% of pneumonectomies.
- These fistulae can be early (operative injury) or late (cancer recurrence, inflammation).
- Empyema thoracis is the common presentation, often with food or saliva in pleural fluid.
Purpose of the Study:
- To review the causes, diagnosis, and initial management of esophagopleural fistulae following pneumonectomy.
Main Methods:
- Review of literature on esophagopleural fistulae.
- Discussion of diagnostic findings including pleural fluid analysis and imaging.
- Outline of initial treatment strategies.
Main Results:
- Early EPF stem from direct esophageal injury or devascularization during surgery.
- Late EPF are typically associated with malignancy recurrence or inflammatory conditions.
- Diagnosis is suggested by characteristic pleural fluid contents and confirmed via contrast swallow studies.
Conclusions:
- Esophagopleural fistulae require prompt diagnosis and management.
- Initial treatment focuses on managing empyema and providing nutritional support.
- Surgical intervention may be necessary for definitive treatment.