Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy.

bronchial tree or after endoscopic dilatation of a benign anasto-motic stricture. Other causative factors have only been reported as solitary cases.4 Among these, we have found in the literature just 1 other case in which the tracheogastric fistula presented in asso-ciation with an auto-expandable esophageal wall-stent prosthesis.5 Symptoms at presentation may range from mild to life-threat-ening.3,4 Yet the possibility of a rapid deterioration of the patient’s general condition should always be kept in mind. Just on suspi-cion, a barium esophagogram should promptly be performed for diagnosis. Treatment is always challenging and has to be individ-ually tailored. It will depend on the severity of symptoms, on the size and location of the fistula, and on accompanying conditions. If surgery is required, the procedure of choice is excision of the fistula and closure of the tracheal and esophageal defects. Inter-position of a pedicled pleural, omental, or muscle flap has proved to be useful in preventing recurrence of the fistula. The gastric tube should be left in place unless judged as an unviable option. In such case, colonic interposition is indicated to restore the continuity of the gastrointestinal tract. If mediastinitis is present, elimination of the septic focus and extensive drainage of the mediastinum are mandatory.3,