80-year-old patient admitted for right lower lobe pneumonia with pleural effusion. He presented a sudden worsening of his respiratory condition and was admitted to the ICU.
Chest drainage was performed, obtaining 2,640 ml of purulent fluid. On the eighth day, the patient began oral tolerance, with diet-like contents coming out of the drain. Suspicion of oesophago-pleural fistula led to the administration of methylene blue, with immediate discharge through the thoracic drainage.
Endoscopy was performed, describing a three-centimetre ulceration in the distal third, right lateral face, covered with fibrin, with a fistulous orifice of more than eight millimetres in its lower part. Biopsies taken from the ulcerated area showed superficial gastric mucosa with mild inflammatory infiltrates and intestinal metaplasia, with no histological signs of malignancy. Once the diagnosis of benign oesophageal pleural fistula in relation to Barrett's oesophagus was confirmed, a removable "Hanoster" type stent was placed as a rescue treatment.

Since leaving the ward, the patient had maintained feverish peaks, so a CT scan was performed, which confirmed the presence of an abscess in the right lower lobe, so an endothoracic drain was placed, with an outflow of chocolate-coloured contents, and the consequent clinical improvement of the patient.
Methylene blue was administered again, and bluish liquid came out through the tube. Given the persistence of the oesophago-pleural fistula, it was decided to transfer the patient to the General Surgery Department.
Oesophagogram: stent in the distal third of the oesophagus, with contrast leakage in the middle third and at the distal end, the latter in a posterior direction.
The patient was operated on and a transhiatal oesophagectomy plus substernal gastroplasty was performed, with a favourable post-operative evolution, the histological study confirming the benign nature of the ulceration.

