Author(s)
Sarah A Gitomer, MD
Shailendra Das, DO
Deepak K Mehta, MD
Affiliation(s)
Baylor College of Medicine
Abstract:
Objective: We present a unique case of bronchoesophageal fistula from an occult foreign body aspiration with an objective to discuss various challenges encountered and its successful management.Method: A case of benign bronchoesophageal fistula was reviewed. The relevant literature was reviewed and is presented. Results: We present a 2-year-old boy who presented to us with a six month history of retained pistachio shell leading to a bronchoesophageal fistula. With gastric contents pouring into to his lungs the first step was to stabilize the patient with a Hood bronchial stent. Once the lungs were stable, formal repair was done with Thoracic, Pediatric and ENT surgeons. The patient had significant bronchial collapse, and therefore a bronchial stent was placed and secured for 6 weeks while the fistula healed. Six months later, the child is doing well with mild esophageal stenosis and near normal swallowing. The bronchial compression is improving but continues to need stenting. Benign airway obstruction is rare in children and there is no consensus on treatment. Airway stents are used most commonly for malignant stenosis in adults, and this technology was adapted for this child with improvement in symptoms.Conclusion: Prompt recognition of airway foreign bodies prevents longterm complications. However, when complications arise, we present techniques utilized in adult malignancies in a novel setting to manage bronchial and esophageal stenosis in a young child. There is varying longterm success with airway stents in adults and children, but it is an option to consider in children with benign bronchial stenosis.