A Case Report of Giant Tracheoesophageal Fistula due to Radiation Therapy for Mucosal Esophageal Cancer Successfully Treated with a Covered Expandable Metal Stent and Surgical Therapy

Shunroh Ohtsukasa, Misao Yoshida, Tomoko Hanashi, Toshimi Mizobuchi, Hiroko Bando, Tasuku Kusano^*, Toshifusa Ozawa^* and Akiharu Yagawa^*

Department of Surgery, Tokyo Metropolitan Komagome Hospital
^*Department of Surgery, Social Insurance Yamanashi Hospital

A 48-year-old man who unsuccessfully underwent an endoscopic mucosal resection for a mucosal esophageal cancer in the upper one-third of the thoracic esophagus, was treated with external and intraluminal radiation therapy. Nine months later, a giant tracheoesophageal fistula was revealed. To prevent pneumonia, a covered expandable metal stent was inserted into the esophagus. His general condition subsequently improved and preoperative evaluation of the lesion was done. An operation to remove the metal stent, to close the esophageal stumps and to cover the distal stump with an omental pedicle flap was carried out and included gastric pull-up and retrosternal esophagogastric anastomosis. Tracheoesophageal fistula is a life-threatening complication of esophageal irradiation. In this case, a covered expandable metal stent was used to close the tracheoesophageal fistula and to prevent pneumonia. The covered expandable metal stent also allowed us to evaluate the lesion and to determine the correct treatment.

Key words
mucosal esophageal cancer, tracheoesophageal fistula, coverd expandable metal stent

Reprint requests
Shunroh Ohtsukasa Department of Surgery, Tokyo Metropolitan Komagome Hospital 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677 JAPAN

Accepted
March 31, 1999

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