Post-pneumonectomy oesophageal fistula

Abstract

The complication of oesophagopleural fistula is described in eight of 1,389 patients (0·5%) who underwent pneumonectomy for carcinoma of the bronchus. All the patients had a right pneumonectomy performed and seven of the eight patients developed a bronchopleural fistula before developing an oesophageal fistula. The complication appeared between two weeks and 22 months after pneumonectomy. All the fistulae occurred on the right side; three were at the level of the bronchial stump and five were within 5 cm below the stump. The cause of the fistula was thought to be the development of a peribronchial abscess which ruptured into the oesophagus. The complication was diagnosed by the presence of food particles on the dressings in those patients with chest drains <i>in situ.</i> It was confirmed by Gastrografin swallow. The size of the fistulae varied between 3 and 8 mm. Successful immediate surgical closure of the fistula was accomplished in three patients. Feeding was continued using a gastrostomy. Five patients unfit for surgery and treated by palliative measures died.