Gastro-bronchial Fistula, an Uncommon Complication of Transhital Esophagectomy: A Case Report

Background: Gastro-bronchial fistulas are rare complication of esophagogastric anostomos operations. They occur either in the early or late postoperative period. They have different etiological factors according to time of development. They have different prognostic feature due to the reason which cause fistulas. Therefore, differential diagnosis of gastro-bronchial fistula should be urgently done as soon as possible. Herein, we present a case of gastro-bronchial fistula which is rare and has valuable radiological findings. Case report: A 41 year old woman who had a cough, dyspnea, dysphagia, weight loss and retrosternal pain was admitted to local government hospital of Van. At the end of evaulation, the diagnosis was consistent with esophageal carcinoma. Then transhiatal esophagectomy with gastric pull-up and cervical anastomosis was performed. Three monhts after surgery, she developed cough, dyspnea and aspiration pneumonia. Therefore, chest X-ray was taken and chest computed tomography (CT) demonstrated gastro-bronchial fistula. After diagnosis of gastro-broncial fistula, the patient was consultated with thoracic surgery department and surgical treatment was decided. The patient was taken to the thoracic surgery department. She was cachectic, therefore total parenteral nutrition was started on. While she was waiting for surgical procedure, she had severe dyspnea. Finally she died due to aspiration and cardiopulmonary arrest. Conclusion: Gastro-bronchial fistula is a rare and devastating complication of esophageal resection that may be diffucult to diagnose. Poor prognosis is mainly due to the development of recurrent chest infections, malnutrition and diffuclty in surgical repairing in contrast to esophageal type. The diagnosis can be done either with bronchoscopy or computed tomography of chest. Surgery and endobronchial stenting are main alternative treatment modalities of this rare and fatal complication of esophagectomy.