[Bronchoesophageal fistula and broncholithiasis]

Area of Science:

• Thoracic Surgery
• Gastroenterology
• Pulmonology

Background:

• Bronchoesophageal fistulas (BEF) are uncommon in adults, with acquired cases secondary to broncholithiasis being exceptionally rare.
• Broncholithiasis, often stemming from calcified mediastinal adenopathy, can lead to the formation of a fistulous tract between the bronchus and esophagus.
• This case highlights a rare etiology of BEF in an adult patient.

Observation:

• A 57-year-old woman presented with cough, expectoration of broncholiths, and hemoptysis, exacerbated by swallowing.
• Imaging revealed calcified mediastinal adenopathy, and diagnostic procedures identified a mid-esophageal bronchoesophageal fistula.
• Bronchoscopy showed a polypoid area in the right main bronchus, with no evidence of malignancy.

Findings:

• The patient was diagnosed with an acquired bronchoesophageal fistula secondary to broncholithiasis.
• A right posterolateral thoracotomy was performed, followed by excision of the fistula and interposition of a pleural bundle.
• The patient experienced an uneventful postoperative recovery and has been doing well during follow-up.

Implications:

• This case underscores the importance of considering broncholithiasis as a rare cause of acquired bronchoesophageal fistulas in adults.
• Successful surgical management demonstrates the efficacy of thoracotomy, fistula excision, and pleural interposition for this rare condition.
• Further investigation into the long-term outcomes of such rare fistulas may be warranted.