[Esophageal bronchial fistula secondary to esophageal diverticulum: A case report and literature review]

Objective: To investigate the clinical characteristics and causes of misdiagnosis of esophageal bronchial fistula secondary to esophageal diverticulum. Methods: A case of esophageal bronchial fistula secondary to esophageal diverticulum was described with regard to its diagnosis and treatment process. A systematic literature review was performed for similar published cases in Wanfang, CNKI and Pubmed databases, using the key words "esophageal diverticulum, esophageal bronchial fistula" from January 1946 to August 2017. Results: The patient was a 52 year-old man with a history of persistent cough with yellow purulent sputum for more than 20 years, which aggravated with hemoptysis for more than a year. He had been hospitalized several times at the local hospitals, and had undergone chest X radiography and computed tomography(CT) several times. He was variably diagnosed with pulmonary infection, bronchiectasis accompanied by infection, and pulmonary abscess. One year ago, the symptoms aggravated with excessive yellow purulent sputum, increased hemoptysis and progressive chest CT lesions. At Peking Union Medical College Hospital, the patient underwent upper gastrointestinal contrast and electronic gastroscopy, and was diagnosed with middle and lower segment esophageal diverticulum complicated with esophageal-bronchial fistula. He was referred to the local thoracic surgery department for a curative procedure. By literature review, we found 15 relevant Chinese articles and 15 English articles. A total of 35 cases had been reported. In 28 misdiagnosed cases, lung infection was the most frequently diagnosed disease(19 cases), followed by bronchiectasis(6 cases) and pulmonary abscess(4 cases). All cases had a history of choking and coughing upon consuming liquids, and were confirmed through upper gastrointestinal contrast and/or electronic gastroscopy. Conclusion: Esophageal bronchial fistula with esophageal diverticulum is a rare condition that can be misdiagnosed as bronchiectasis or chronic pulmonary abscess, due to the similarities in their clinical manifestations and imaging features. Detailed history-taking and upper gastrointestinal contrast, gastroscopy and/or bronchoscopy are useful for a timely and correct diagnosis. The recommended treatment for esophageal fistula secondary to esophageal diverticulum is immediate surgery.