Atma Jaya School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia North Jakarta, Jakarta Raya, Indonesia
Riki Tenggara, MD1, Margareth Gracia, MD2, Muhammad Begawan Bestari, MD, PhD, FACG3; 1Atma Jaya School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta Raya, Indonesia; 2Pantai Indah Kapuk Hospital, Jakarta, Jakarta Raya, Indonesia; 3Hasan Sadikin General Hospital Universitas Padjadjaran, Bandung, Jawa Barat, Indonesia
Introduction: Bronchoesophageal fistula (BEF) is a pathological communication between the bronchial tree and the esophagus. The fistula usually results from congenital, chest trauma, chronic granulomatous infections, ingestion corrosive substances and esophageal or pulmonary malignancies. BEF is a life-threatening condition and reported in 5-10% of patients with esophageal cancer.
Methods: A 69 years old man was admitted to the hospital with chief complain of swallowing difficulty for 3 days. Evaluation of muscular and neurological of swallowing movement was performed. Every time he swallowed food or liquid, it was followed by cough and brownish sputum. He experienced shortness of breath while laying down. He was still an active smoker. He had lost weight 5 kg in one month. He had no prior medical history. His physical examination revealed hypertension stage I and tachypnea. CXR only showed small infiltrate at right peri bronchial. Gastrointestinal endoscopy was performed, and the bronchial tree was seen at the middle of the esophagus. Bronchoscopy was then performed which confirmed a mass and fistula between the right bronchus and esophagus. Biopsy was taken resulting bronchogenic adenocarcinoma. Chest CT scan also showed a mass around peri bronchial with fistula on esophagus connected to bronchus. The esophageal Self-Expandable Metallic Stent (SEMS) was inserted to seal the fistula then allowing the patient to take food orally.
Discussion: BEF is a life-threatening condition which if left untreated will lead to overwhelming sepsis and death. Isolating the bronchus from the esophagus remains the basis of management of this pathology which can be achieved through the insertion of an esophageal SEMS.
Bronchogenic tutor from gastroscopy view
Bronchogenic tumor from gastroscopy view
Self Extended Metallic Stent to seal the fistula
Disclosures: Riki Tenggara indicated no relevant financial relationships. Margareth Gracia indicated no relevant financial relationships. Muhammad Begawan Bestari indicated no relevant financial relationships.