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Congenital bronchoesophageal fistula in an adult
1Department of Surgery, National Naval Medical Center, Bethesda, MD 20889, USA.
Insights
A rare congenital bronchoesophageal fistula, unassociated with esophageal atresia, can manifest in adulthood. Early diagnosis is crucial for individuals with unexplained respiratory issues and suggestive symptoms.
Area of Science:
- Medicine
- Pulmonology
- Gastroenterology
Background:
- Congenital bronchoesophageal fistulas are rare anomalies.
- They may remain undiagnosed until adulthood, often presenting with recurrent pulmonary infections or gastrointestinal issues.
Observation:
- A 54-year-old woman with a history of feeding intolerance and recurrent pulmonary infections presented with abdominal pain.
- A barium esophagogram identified a fistula between the mid-esophagus and the left lower lobe bronchus.
Findings:
- Surgical intervention involved fistula division, left lower lobe superior segmentectomy, and esophageal closure reinforced with intercostal muscle.
- The patient experienced immediate relief from postprandial coughing post-surgery.
Implications:
- Congenital bronchoesophageal fistulas, even without esophageal atresia, can present late in life.
- Consideration of this diagnosis is vital in patients with unexplained respiratory pathology and relevant symptoms.
Abstract:
We present a rare case of a congenital bronchoesophageal fistula in a 54-year-old woman with a history of poor feeding tolerance since infancy and repeated pulmonary infections. She initially presented with epigastric and right upper quadrant abdominal pain. Her workup included a barium esophagogram that revealed a fistula between her midesophagus and a left lower lobe segmental bronchus. The fistula was divided, a left lower lobe superior segmentectomy was performed, and an intercostal muscle was placed over the esophageal closure. The patient noted an immediate decrease of postprandial coughing. Congenital respiratory esophageal fistulas that are not associated with esophageal atresia may persist into adulthood before they become clinically apparent. The diagnosis should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology.