The Journal of Thoracic and Cardiovascular Surgery, Vol 69, 820-826, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Malignant tracheoesophageal fistula secondary to Hodgkin's disease. Successful surgical treatment with free fascia-muscle graft and left colon bypass
A Lambert
A case of malignant tracheoesophageal fistula due to Hodgkin's disease at
the mediastinum and mid-third of the esophagus is reported. The fistula
developed after x-ray therapy (2,000 rads) to the medistinum. In another
hospital, she had undergone two unsuccessful attempts to close the fistula
surgically with muscle flap grafts, following tracheostomy and feeding
gastrostomy. The third operation, performed successfully 2 months later at
The Roosevelt Hospital, included division of the esophagus above the
fistula with cervical esophagostomy. A free muscle graft was used to close
the fistula in the trachea. One month later, subcutaneous antiperistaltic
left colon bypass was performed in one stage to connect the cervical
esophagus with the lower stomach. At the same time, distal closure of
esophagus at the cardia, pyloroplasty, and splenectomy were done. These
operations allowed that time, recurrence of the fistula necessitated a
fourth operative repair. This time, a 2 inch square piece of fascia and its
underlying muscle from the gluteus medius were used to reinforce the
closure. The fistula remains closed to date.
