Introduction

• Fistula involving esophagus and tracheobronchial tree (occasionally between esophagus and pleura or cervical tissues).
• Rare.
• Cause: congenital or acquired (esophageal foreign bodies resulting in transmural necrosis; neoplasia; necrosis of esophageal diverticulum; peri-esophageal inflammatory focus).
• Signs: non-specific related to causal condition, disease often overlooked in first instance. As condition progresses - chronic cough, regurgitation, pyrexia, dyspnea, lethargy.
• Diagnosis: history, clinical signs, radiography, esophagoscopy.
• Treatment: surgical repair of fistula (with or without lobectomy of infected lung).
• Prognosis: related to degree of respiratory involvement.

Pathogenesis

Etiology

• Congenital.
• Esophageal foreign bodies Esophagus: foreign body.
• Neoplasia Esophagus: neoplasia.
• Necrosis of esophageal diverticulum Esophagus: diverticulum.
• Peri-esophageal inflammatory focus.

Pathophysiology

• Congenital or acquired.
• Transmural necrosis as a result of esophageal foreign body, necrosis of esophageal diverticulum, peri-esophageal inflammatory focus, or neoplasia.
• Leads to fistula development between esophagus and tracheobrachial tree (pleura or cervical tissues - rarely).

• Most commonly caused by esophageal foreign body → base of heart → chronic cough and respiratory disease ensue.
• Transmural necrosis → to fistula formation between esophagus and tracheobronchial tree (occasionally pleura or cervical tissues).
• Contamination of respiratory tract with esophageal contents.

Timecourse

• Days.

Diagnosis

Treatment

Outcomes