A Case Report Of Congenital Esophago-Bronchial Fistula With Two Diverticula In The Adult

Congenital esophago-bronchial fistula in the adult is extremely rare and its accurate diagnosis is difficult. Recently we treated a patient who provided significant information concerning the occurrence, pathogenesis, and explanation for the functional closure and late diagnosis of this anomaly. The patient was a 68-year-old man, who had two diverticula on the right wall of the mid-esophagus. A tiny fistula originating in the distal diverticulum had gradually developed during four years to a thicker one which directly communicated with the right B₇ segmental bronchus. Another thick chord, which had not been detected by X-ray examination, was present between the proximal diverticulum and the right lower lobe of the lung. Repair was carried out by fistulectomy with an uneventful recovery. According to the criteria proposed by Brunner and Karasawa, the disease in this case was assumed to be of congenital origin. Several aquired factors, such as reduced tissue elasticity with aging, heavy smoking and ingestion of alcohol, and frequent aspirations into the lung, will accelerate the force which enlarges the inside wall of the narrow duct.