Repair of a Bronchoesophageal Fistula Using a Pericardial U-Flap

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Surgical Complications

Background:

• Bronchoesophageal fistula (BEF) is a severe, infrequently reported complication following esophagectomy, often stemming from esophagogastric anastomosis leaks.
• Patient history of esophageal malignancy and prior neoadjuvant chemoradiation can increase predisposition to BEF formation.

Observation:

• A 71-year-old male with a history of esophageal cancer developed respiratory symptoms two weeks post-Ivor-Lewis esophagectomy, diagnosed as BEF via imaging.
• Initial management involved serial operating room interventions for lysis of adhesions, debridement, and endoluminal sponge vacuum-assisted closure (VAC) as a temporizing measure.
• The patient required intensive care unit (ICU) support and frequent procedures for approximately one month before definitive surgical repair.

Findings:

• Definitive surgical repair with esophageal exclusion was successfully performed after initial stabilization and optimization of fistula tissue.
• The patient recovered and was discharged 60 days post-operatively, with ongoing follow-up for symptom assessment and imaging.

Implications:

• This case underscores the critical need for prompt diagnosis and aggressive management of post-esophagectomy BEF.
• Timely surgical intervention, potentially bridging with less invasive techniques, can lead to improved outcomes in this challenging complication.