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 14 December 2017

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GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

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GastroenterologyEsophagus

Malignant diseases

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Squamous carcinoma of the esophagus.
A 61-year-old woman underwent an oesophagectomy for a mid-third squamous cell carcinoma. Surgery was preceded by neo-adjuvant chemoradiotherapy. Four weeks after operation - and one day after she went home - the patient was re-admitted with vomiting. An anastomotic leak was found. One week after re-admission she developed a cough. The endoscopy (a) shows the oesophago-gastric stoma to the left and the partially dehisced anastomosis in the centre, looking into the abscess cavity. Shifting the endoscope to the right (b), brought the carina and left and right main bronchi on view. The endoscope was then withdrawn and an endonasal scope inserted into the trachea (c). The large fistulous communication is readily seen on the posterior tracheal wall immediately above the carina.

Tracheo-oesophageal fistulae are uncommon and usually occur in association with malignancy. Other causes include radiotherapy and trauma. Unless treated promptly, the patient will die of respiratory inhalation and infection. Endobronchial and endo-oesophageal stenting is the preferred option. In this case, the position of the fistula does not make stent insertion a feasible option. Surgical intervention involves proximal and distal diversion (oesophagostomy and gastrostomy).

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Peter Devitt, Adelaide, Australia

Squamous carcinoma of the esophagus.

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