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J Thorac Cardiovasc Surg 2010;139:e37-e39
© 2010 The American Association for Thoracic Surgery

Brief Clinical Report

Benign gastrobronchial fistula with adenocarcinoma of the right mainstem bronchus

Simon Turcotte, MD, MSca, Isabelle L. Cayer, MDa, Jean-Luc Laporte, MDb, Pasquale Ferraro, MDa, Jocelyne Martin, MD, MSca, André Duranceau, MDa,*

a Department of Surgery and Division of Thoracic Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
b Department of Pathology, Université de Montréal, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada

Received for publication June 19, 2008; accepted for publication July 26, 2008.

* Address for reprints: André Duranceau, MD, Department of Surgery, Université de Montréal, Division of Thoracic Surgery, Centre hospitalier de l'Université de Montréal, 1560 Sherbrooke E., Montreal, Quebec, Canada, H2L 4M1. (Email: andre.duranceau@umontreal.ca).

The first 20% of the full text of this article appears below.


   Introduction
 
Fistulization of the gastric conduit into the tracheobronchial tree is a potential complication after esophageal reconstruction. In this situation, the effects of the refluxate on the mucosa of the tracheobronchial tree is unknown. This article presents the 11-year evolution of a patient who tolerated a fistulous communication between the gastric interposition and the right mainstem bronchus, resulting in an adenocarcinoma of the bronchus.


   Clinical Summary
 
A 38-year-old man underwent an Ivor Lewis resection of a T3N1M0 distal esophageal adenocarcinoma. An esophagogastrostomy was completed above the azygos arch. All margins were negative. Metastasis was documented in 4 of 9 nodes. Within months of the operation, incapacitating reflux symptoms were present and controlled by antireflux medication. An asthma episode with a bout of hemoptysis prompted reinvestigation 1 year later. Esophagitis was found in the esophageal remnant without evidence of cancer or ulceration in the gastric reconstruction. Nonspecific changes were observed in the bronchial tree. Nineteen months after the esophagectomy, a new bronchoscopy documented a minute hole on the membranous wall of the right mainstem bronchus . . . [Full Text of this Article]






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