Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.
Bronchial Diseases/congenital* ; Bronchial Diseases/complications* ; Case Report ; Diverticulum, Esophageal/complications* ; Esophageal Diseases/congenital* ; Esophageal Diseases/complications* ; Female ; Fistula ; Human ; Middle Age

BACKGROUND: Benign esophageal diseases are less common indications for an esophagectomy. The indications for an esophagectomy have not been clearly defined for benign esophageal diseases. The purpose of this study was to defermine whether an esophagectomy should be performed for benign esophageal disease and the indications for an esophagectomy. METHODS: The postoperative morbidity and mortality were examined in 11 patients who had received esophagectomy and esophageal reconstruction for benign esophageal diseases between 1981 and 1996 in this hospital. The indications were identified. RESULTS: The indications included corrosive stricture (6 cases), recurrent achalasia (2 cases), accidental esophageal perforation (1 case), a esophageal diverticulum with stricture (1 case) and suspicion of malignancy (1 case). All of the patients with recurrent achalasia had undergone at least one prior esophageal operation, and all of the patients with stricture had had at least one esophageal dilation previouly. There was no postoperative mortality after the esohagectomies. Postoperative complications developed in 7 patients. Early complications were anastomotic leakage (3 cases), bronchopneumonia (1 case) and DIC & ARDS (1 case). Later complications were intestinal obstruction (1 case), anastomotic bleeding (1 case) and anastomotic stenosis (4 cases) which needed one or two dilation procedures to improve the symptoms. CONCLUSION: Although an esophagectomy for benign esophageal diseases resulted in high morbidity, there were no mortalities. Thus, an esophagectomy should be considered for benign conditions of the esophagus because of corrosive cancer and the end-stage of motility disorders.
Anastomotic Leak ; Bronchopneumonia ; Constriction, Pathologic ; Dacarbazine ; Diverticulum, Esophageal ; Esophageal Achalasia ; Esophageal Diseases* ; Esophageal Perforation ; Esophagectomy* ; Esophagus ; Hemorrhage ; Humans ; Intestinal Obstruction ; Mortality ; Postoperative Complications

A 68-yr-old man complaining of sudden, postprandial chest pain visited the emergency room. His symptom had been aggravated during the preceding two days. Upper gastrointestinal contrast study with gastrographin showed leakage of dye from the epiphrenic diverticulum in the lower third of the esophagus. The primary repair was urgently carried out. Upper gastrointestinal contrast study 14 days after operation revealed an esophageal leakage which was small and confined. The patient was managed with conservative treatments such as intravenous hyperali-mentation and broad-spectrum antibiotics. Forty-two days after the operation, a gastrographin swallow study showed the absence of leaks. This is the first report-ed case of a perforated epiphrenic esophageal diverticulum repaired by delayed primary repair in Korea.
Aged ; Diverticulum, Esophageal/complications/*diagnosis/*surgery ; Esophageal Perforation/*diagnosis/etiology/*surgery ; Esophagectomy/*methods ; Humans ; Male ; Research Support, Non-U.S. Gov't ; Time Factors ; Treatment Outcome

The history of esophageal replacement in infants or children is the history of development of various kinds of alternative conduits such as stomach, colon, and small bowel. The gastric tube has been the most widely used conduit. From January 1988 to May 2003, 23 esophageal replacements with gastric tube were performed at the Department of Pediatric Surgery, Seoul National University Childrens Hospital. Statistical analysis was performed using Windows SPSS11.0 Pearson exact test. There were Gross type A(n=10), type B(n=1), type C(n=11), type D(n=1). Ten patients who had long gap esophageal atresia (type A-8, type B-1, type C-1) and 13 patients (type A 2, type C-10, type D-1) who had stenosis, leakage, recurred tracheoesophageal fistula, and esophagocutaneous fistula after previous corrective operations, had esophageal replacement with gastric tube. Mean follow-up periods were 4 year 2 months (7 months-15 year 1 month). There were postoperative complications including GERD in 16 (69.6 %), leakages in 7 (30.4 %), diverticulum at anastomosis in 2 (8.7 %), anastomosis site stenosis in 4 (17.3 %), and distal stenosis of the gastric tube in 1 (4.3 %). There was no statistical significance between operation types and postoperative leakage and gastroesophageal reflux. In conclusion, esophageal replacement with gastric tube may be a useful surgical option in esophageal atresia with long gap and esophageal atresia complicated by previous corrective operation.
Child ; Colon ; Constriction, Pathologic ; Diverticulum ; Esophageal Atresia* ; Fistula ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Infant ; Postoperative Complications ; Seoul ; Stomach ; Tracheoesophageal Fistula