Treatment of an acquired esophageal-bibronchial benign fistula using an original combination of techniques
Maurizio Boaron 1,
Kenji Kawamukai 1,
Sergio Nicola Forti Parri 1,
Rocco Trisolini 1*
1 Maggiore and Bellaria Hospital, Bologna, Italy
* To whom correspondence should be addressed. E-mail: rocco.trisolini{at}ausl.bologna.it.
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Abstract |
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We report on the successful surgical treatment of an esophageal-bibronchial fistula originating from a iatrogenic mediastinal abscess. Endoscopic treatment had been excluded due to the extensive damage to the right main stem bronchus wall. The surgical treatment was carried out as follows: 1) Endoscopic stenting of the left main broncus with a self-expanding metallic stent followed by selective left main bronchus intubation; 2) Laparotomic harvesting of the omentum pedicled on both gastro-epiploic vessels; 3) Right thoracotomy, complete dissection of both main bronchi and esophageal wall at the site of the leakage; 4) Harvesting of a pericardial vascularized graft; 5) Deployment of a self-expanding metallic stent from the surgical field into the right main stem bronchus; 6) Reconstruction of the right bronchus wall with the pericardial patch; 7) Positioning a T-tube in the esophageal leak; and 8) Intrathoracic transposition of the omental graft for buttressing all sutures and potential leakage points. The postoperative course was uneventful from a surgical point of view and the patient recovered completely. Keywords: Esophageal fistula; Bronchial fistula; Bronchial stent; Pericardial patch
