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Multiple infectious esophageal fistulae.

L E Kowal, L R Goodman, S K Teplick

The American Journal of Gastroenterology

|May 1, 1983

Summary

Acquired fistulous communication between the respiratory tract and esophagus is often due to trauma or cancer. Double contrast esophagography can identify infectious causes, especially when multiple fistulae are present.

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Area of Science:

Gastroenterology
Pulmonology
Radiology

Background:

Acquired fistulous communications between the respiratory tract and esophagus in adults are typically posttraumatic or malignant.
Infectious etiologies are uncommon but can arise from esophageal, mediastinal, or pulmonary sources.

Observation:

Double contrast esophagography offers improved mucosal definition for identifying the origin of esophagopulmonary communications.
Near-maximal esophageal distension during esophagography can reveal multiple, widely separated fistulae, suggesting an infectious origin.

Findings:

This study presents two cases of multiple esophagopulmonary communications, a previously unreported entity in English literature.
Barium studies in these cases accurately predicted an infectious etiology for the fistulae.

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Implications:

Double contrast esophagography is a valuable tool in the differential diagnosis of esophagopulmonary fistulae.
Identifying multiple, widely separated fistulae via esophagography may indicate an infectious process, guiding appropriate management.