Late esophageal fistula complicating early postpneumonectomy empyema

Esophageal fistula after pulmonary resection is a rare and severe complication. We report a case of acute postpneumonectomy empyema and bronchopleural fistula treated conservatively and complicated 2 years later by an esophageal fistula. A chest wall window was created to stimulate the granulation tissue and, once a satisfactory result was achieved, a myoplasty was performed to fill the residual space and cover the esophageal fistula. Consecutive endoscopic examinations following surgery showed the complete closure of the esophageal defect and the patient was able to start oral feeding. We conclude that, when esophageal fistula complicates postpneumonectomy empyema, a two-step surgical approach based on rib resections and muscle flaps transposition can be an effective treatment of a dramatic complication.