Congenital Broncoesophageal Fistula Presenting in Adults

Abstract

Bronchoesophageal fistulas are usually diagnosed in the neonatal period. As such, the condition is rare in adults. We present a case of congenital bronchoesophageal fistula in a 47-year-old man who presented with the complaints of severe bouts of cough and choking after eating and the symptoms were more with the liquids. He was also complaining of gradually worsening dysphagia since last one year. His routine blood hematological and biochemistry investigations were normal. Further workup included upper gastrointestinal endoscopy which revealed mid-esophageal diverticulum and fistula between the esophagus and a left bronchus. The CT chest revealed bronchiectasis of the left lower lobe with left lower lobe bronchoesophageal fistula. The esophageal mannometry study showed generalized failure of peristalsis of the esophagus. The patient was taken up for surgery after pre-anesthesia check. He underwent left posterolateral thoracotomy and left lower lobectomy with division and repair of the fistula in two layers. Intercostal muscle graft taken on intercostal vessels was used as interposition. Esophageal myotomy from aortic arch to gastro-esophageal junction was done. The patient had an uneventful general postoperative recovery and on discharge was asymptomatic and tolerating normal diet. The diagnosis of bronchoesophageal fistula should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology. Also the association of esophageal motility disorder should be kept in mind in managing patients with bronchoesophageal fistulas.