Esophageal Carcinoma With Tracheoesophageal Fistula

May 1, 2006

An 84-year-old woman presented with a 10-month history of dysphagia to solids and a 4-month history of dysphagia and coughing to liquids. She was severely dehydrated and cachectic; over the past 10 months, she had lost 16.2 kg (36 lb). Rhonchi and gurgling sounds were audible on auscultation of the chest.

 

An 84-year-old woman presented with a 10-month history of dysphagia to solids and a 4-month history of dysphagia and coughing to liquids. She was severely dehydrated and cachectic; over the past 10 months, she had lost 16.2 kg (36 lb). Rhonchi and gurgling sounds were audible on auscultation of the chest.

Christopher C. Brodkin, MD, of the John H. Stroger Jr Hospital of Cook County, Chicago, reports that an esophagram demonstrated a communication between the esophagus and the left main bronchus (A, black arrow). High-resolution CT revealed a mass in the mid esophagus with a communication to the left main bronchus (B, red arrow).

Esophageal carcinoma with tracheoesophageal fistula was diagnosed based on the results of esophagogastroduodenoscopy with biopsy. The cancer was classified as stage 3 because it had eroded through the esophagus, but no metastases were found. Shortly after the patient received the diagnosis, aspiration pneumonia developed, followed by respiratory failure. She was resuscitated, and mechanical ventilation was started.

When the patient regained consciousness and was extubated, she declined esophageal resection and requested a "do not resuscitate" order. For palliation, an esophageal stent was placed under endoscopic and fluoroscopic guidance. This stent occludes the fistula, allows the patient to eat and sleep, prevents cough, decreases tracheal leakage and sialorrhea, and improves quality of life. Complications of stent placement include esophageal perforation, dysphagia related to loss of peristalsis of a portion of the esophagus, aspiration caused by acid reflux, and stent migration.1

This patient's condition initially improved after stent placement. However, 2 days later, persistent aspiration pneumonia led to respiratory failure, and she died.

References:

REFERENCE:


1.

Boyce HW Jr. Palliation of dysphagia of esophageal cancer by endoscopic lumen restoration techniques.

Cancer Control

. 1999;6(1). Available at:

https://www.moffitt.usf.edu/pubs/ccj/v6n1/article7.html

. Accessed April 18, 2006.