INTRODUCTION: An acquired bronchoesophageal fistula (BEF) in adult is a rarely encountered entity in clinical practice. It is a serious complication of malignancy and trauma. Although rare, acquired BEF can occur as a consequence of tuberculosis, HIV infection, and histoplasmosis. Patients usually present with recurrent lower respiratory tract infections. We report a rare case of bronchoesophageal fistula presenting as abdominal pain. CASE PRESENTATION: A 78-year old man was referred to us with a 1-month history of abdominal discomfort. He had a history of pulmonary tuberculosis 2 years prior for which he was asymptomatic. He had no history of trauma or prolonged mechanical ventilation. He had mild pallor with clear breath sounds. Chest x-ray showed fibrotic densities on both upper lobes with volume loss on the left. Barium swallow showed a fistulous communication between the esophagus and the left main bronchus. Esophagogastroduodenoscopy was done which showed a 0.5cms opening at 25cms level with a visualized tract. On bronchoscopy, there was a fistula between the of 5th and 6th bronchial rings measuring 1cm. Bronchial washing was negative for acid-fast bacilli. Surgery was discussed, however, patient and family refused. DISCUSSION: An acquired bronchoesophageal fistula (BEF) is a rare but serious complication of malignancy and trauma. A patent tract from the airway to the upper gastrointestinal tract bypasses the normal protection offered by laryngeal reflexes. Malignancy is the most common cause of which 77% are attributable to esophageal tumors and 16% are secondary to pulmonary primaries . Of the non-malignant etiologies, 75% are related to trauma from prolonged mechanical ventilation . The most characteristic symptom is paroxysmal coughing particularly after ingestion of liquids (Ono's sign) . Other symptoms include fullness of stomach with air following expiration. The development of BEF in tuberculosis is related to mediastinal lymph node involvement. This is a spontaneous BEF, as a definite underlying cause could not be identified except for the past history of pulmonary tuberculosis. CONCLUSIONS: Acquired spontaneous bronchoesophageal fistula with an unusual presentation of abdominal pain, developing as a delayed sequela of pulmonary tuberculosis is a rare condition.
Patel, S., Abraham, V. J., Mathur, R. M., Devgarha, S., & Yadav, A. (2015). Acquired spontaneous bronchoesophageal fistula in an adult. Egyptian Journal of Chest Diseases and Tuberculosis, 64(1), 209–211. https://doi.org/10.1016/j.ejcdt.2014.09.007