Esotracheal Fistula in Esophageal Stenoses of Malignant Origin - Case Report.

BACKGROUND Approximately 80% of acquired eso-tracheal or mediastinal fistulae are of malignant nature. The occurrence of an eso-respiratory malignant fistula is a devastating complication for both patient and doctor, and, if not treated, records a survival time of 1 to 6 weeks. MATHERIAL AND METHOD We present a patient, aged 51, smoker,with progressive dysphagia, at first to solids, then to semi-solids and liquids, followed by manifestation of post-deglutition cough due to eso-tracheal fistula, incapability of feeding, and decline of the general condition. Surgical intervention consists of esophageal transstenotic endo-prosthesing by transtumoral drilling with prosthetic montage and the occlusion of the eso-tracheal fistulous orifice. RESULTS The post-operatory evolution is favorable, the feeding per os resumes in 8 hours after surgery, good digestive tolerance. The radiologic examination using contrast medium, performed in 48 hours after surgery, reveals a permeable esophageal endo-prosthesis, without reflux of contrast substance in the tracheobronchial tree. CONCLUSIONS The laparo-gastroscopic montage of prosthesis through transtumoral drilling, using siliconized semi-rigid prostheses, represents the only efficient palliative treatment of malignant eso-tracheal or eso-bronchial fistula.