Bronchoesophageal Fistula From Self-Induced Vomiting

Andrew Korman, MD; Maria F. Kassab, MD; Lan S. Wang, MD; Byron D. Patton, MD; Robert Loree, MD; Angelo T. Reyes, MD; David L. Carr-Locke, MD


May 25, 2011

Bronchoesophageal Fistula

A bronchoesophageal fistula (BEF) is an uncommon diagnosis that may be congenital or acquired. In 1697, Thomas Gibson was first to report a case of an infant with congenital esophageal atresia and a tracheoesophageal fistula (TEF). Primary esophageal cancers[1,2] are the most common cause of an acquired BEF. Other causes of acquired BEF include cuff-related trauma secondary to endotracheal intubation, infections such as pulmonary tuberculosis and, less commonly, ulcerations from Barrett's esophagus.[1,3] Patients typically present with nonspecific symptoms, including cough, abdominal pain, hemoptysis, and recurrent respiratory tract infections.[3,4]

The first successful surgical repair was performed by Cameron Haight in 1941. With advancement of technique since that time, surgery is now usually curative.[4] Endoscopic surgical techniques have yet to be developed. Anatomic correction of the fistula prevents chronic complications, such as persistent aspiration, pulmonary sepsis, and even death.[5]

The authors present a case of acquired BEF in a man with a history of self-induced vomiting.