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Also known as: '''''Oesophago-tracheal fistula — Oesophago-bronchial fistula — Broncho-oesophageal fistula — Oesophago-pulmonary fistula
==Introduction==
An oesophageal fistula is an abnormal connection between the oesophageal lumen and a structure in its immediate vicinity, most commonly the lungs or other respiratory structures (producing a '''bronocho-oesophageal fistula'''). In rare cases, fistulae may be congenital but they are usually acquired phenomena. Acquired oesophageal fistulae occur when severe inflammation or disruption of the oesophageal wall leads to [[Rupture of the Oesophagus|perforation]] and, as this heals, a tract is formed with the respiratory system. Causes of the initial insult include [[Oesophageal Foreign Body|foreign bodies]], [[Oesophageal Neoplasia|neoplasia]] and severe [[Oesophagitis|oesophagitis]]. Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.
An oesophageal fistula is an abnormal connection between the oesophageal lumen and a structure in its immediate vicinity, most commonly the lungs or other respiratory structures (producing a '''bronocho-oesophageal fistula'''). In rare cases, fistulae may be congenital but they are usually acquired phenomena. Acquired oesophageal fistulae occur when severe inflammation or disruption of the oesophageal wall leads to [[Rupture of the Oesophagus|perforation]] and, as this heals, a tract is formed with the respiratory system. Causes of the initial insult include [[Oesophageal Foreign Body|foreign bodies]], [[Oesophageal Neoplasia|neoplasia]] and severe [[Oesophagitis|oesophagitis]]. Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.
==Treatment==
==Treatment==
Surgical repair of the fistula is required to prevent continued leakage of ingesta into the respiratory tract or mediastinum. An oesophagotomy incision is made to excise the fistula and the defect in the wall is then closed in a longitudinal orientation to reduce the risk of stricture formation. If one or more lobes of the lung are severely consolidated due to the presence of ingested material, these may be removed in a complete lobectomy. Any oesophageal foreign bodies should be removed as described [[Oesophageal Foreign Body#Treatment|here]].
Surgical repair of the fistula is required to prevent continued leakage of ingesta into the respiratory tract or mediastinum. An oesophagotomy incision is made to excise the fistula and the defect in the wall is then closed in a longitudinal orientation to reduce the risk of stricture formation. If one or more lobes of the lung are severely consolidated due to the presence of ingested material, these may be removed in a complete lobectomy. Any [[Oesophageal Foreign Body#Treatment|oesophageal foreign bodies should be removed]].
Post-operatively, food should be withheld for 24-48 hours and the animal should receive only soft food thereafter. Sucralfate can be used to reduce any residual oesophagitis or ulceration and the patient should receive a full (4-6 week) course of antibiotics to clear any remaining respiratory infection. The choice of antibiotic should ideally be guided by culture of pulmonary fluid obtained during a lobectomy, if this is performed.
Post-operatively, food should be withheld for 24-48 hours and the animal should receive only soft food thereafter. Sucralfate can be used to reduce any residual oesophagitis or ulceration and the patient should receive a full (4-6 week) course of antibiotics to clear any remaining respiratory infection. The choice of antibiotic should ideally be guided by culture of pulmonary fluid obtained during a lobectomy, if this is performed.
==Prognosis==
==Prognosis==
If surgical removal is successful, the prognosis is very good. If post-operative complications develop, the prognosis is guarded.
If surgical removal is successful, the prognosis is very good. If post-operative complications develop, the prognosis is guarded.
{{Learning
|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00641.asp, Oesophagobronchial fistula]
|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28oesophag*%29+OR+title%3A%28esophag*%29+OR+title%3A%28tracheoesopageal%29+OR+title%3A%28bronchoesophageal%29%29+AND+title%3A%28fistula%29 Oesophageal Fistula publications]
}}
==References==
==References==
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
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[[Category:Oesophagus_-_Pathology]]
[[Category:Oesophagus_-_Pathology]]
[[Category:To_Do_-_James]]
[[Category:Oesophageal Diseases - Cat]][[Category:Oesophageal Diseases - Dog]]
[[Category:To_Do_-_Review]]
[[Category:Expert_Review]]