Esophageal fistulae. Results of conservative treatment

Twenty-one consecutive cases of esophageal fistulae (EF), were studied to assess their etiology, the associated thoracopulmonary pathology and evaluate the usefulness of simultaneous partial exclusion of the esophagus and treatment of the present thoracopulmonary complications. EF were 6 cervical, 13 thoracic and 2 abdominal. The different types were: esophagopleural 8, esophagotracheal 7, esophagobronchial 1, congenital 1 and diverse type 4. Tracheal manipulation was the cause in 6, mistaken surgical procedures were an important etiologic factor in 9, improper use of dilators in 3 and different causes in 3. Esophageal reflux was the common antecedent, but 9 cases had normal esophagus before the EF. Pleural empyema, mediastinitis and aspiration pneumonia were major complications, two cases had subphrenic abscess. Treatment was based on partial exclusion of the esophagus, drainage of pleural and mediastinal infections, proper antimicrobial therapy and nutritional support. Four required thoracotomy. Eighteen patients were cured and 3 died.