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then withdrawn and an endonasal scope inserted into the trachea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
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