Esophagopleural fistula after pneumonectomy for inflammatory disease

The development of an esophagopleural fistula after pneumonectomy is one of the less common complications of pneumonectomy. Herein reported are seven cases over a period of 14 years, five from a series of 896 pneumonectomies performed for malignant or inflammatory disease in the Department of Thoracic Surgery and two referred after pneumonectomy elsewhere. The fistula was demonstrated by the escape of radiographic contrast material, methylene blue, or food particles into the pleural space or was observed at esophagoscopy. In all, the associated empyema was first treated by drainage, and surgical repair of the fistula was attempted in only three cases. In six cases the fistula had closed before the patient left hospital. In the seventh, the patient insisted on leaving the hospital while under treatment and before closure had occurred. One patient died of cor pulmonale 2 years after closure of the fistula. There has been no recurrence of the fistula in any of the patients observed. Conservative management is at variance with that of many authors.