Treatment difficulties of malignant esophagorespiratory fistula: Case report of a 56-year-old patient with esophageal cancer

IntroductionAn esophagorespiratory fistula (ERF) is a lethal complication of advanced esophageal cancer. The preferred treatment method is placing a self-expanding stent, which is expected to decrease the risk of life-threatening complications.AimIn the case study we present a patient with esophageal cancer complicated with the presence of ERF, pneumonia, lung abscess and severe malnutrition.Case studyA 56-year old man was hospitalized due to short syncope, dyspnea and cough. Cachexia was apparent. Immediate diagnostics with chest X-ray, bronchoscopy, gastroscopy and computed tomography (CT) of the chest revealed esophageal cancer and presence of ERF with respiratory complications. Endoscopic stent placement significantly decreased the initial symptoms. The patient was later re-admitted due to recurrent respiratory infections, dysphagia and progressing cachexia. He required stent placement again, parenteral alimentation and prolonged antibiotic therapy. From the diagnosis he survived 28 weeks.Results and discussionThe average survival of patients with diagnosed ERF is about 8 weeks. The palliative treatment is expected to reduce bronchial aspirations and to prevent dysphagia. The recommended method is the insertion of esophageal stent to unblock the gastrointestinal tract and to close the fistula simultaneously. Reopening of the ERF is a severe complication caused mostly by progressing neoplasm. Successful surgical treatment of primary or recurrent fistulas is only probable in patients with good or moderate performance status.ConclusionsAn immediate implementation of diagnostic and therapeutic methods is necessary, as the time to diagnosis and treatment of a malignant fistula strongly influences the patient's survival and quality of life.