An 80-year-old patient was admitted for pneumonia in the right lower lobe with pleural effusion.
She presented sudden worsening of her respiratory condition and was admitted to the ICU.
Chest drain was placed, obtaining 2,640 ml of purulent fluid.
On the eighth day, the patient began oral tolerance, leaving a content similar to the diet by drainage.
The suspicion of oesophagus-pleural fistula led to the administration of methylene blue, demonstrating immediate exit through the thoracic drainage.
Endoscopy was performed, describing in the distal third, right lateral face, an ulceration of three centimeters, covered with fibrin, with a fistulous orifice of more than eight millimeters in its lower part.
Biopsies taken from the ulcerated area showed superficial gastric mucosa with mild inflammatory infiltrates and intestinal metaplasia, without histological signs of malignancy.
Once the diagnosis of benign esophageal pleural fistula was confirmed in relation to esophageal stricture, a removable "Hanoster" stent was placed as rescue treatment.
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Since the patient was discharged to the plant he had feverish peaks. CT scan confirmed the presence of an abscess in the right lower lobe, so an endothoracic drainage was placed and the resulting clinical improvement was observed.
Methylene blue was re-administered with blue solution through the tube.
Therefore, due to the persistence of esophageal-pleural fistula, the patient was referred to the General Surgery service.
Pathogram: Endoprosthesis in the distal esophageal third, with contrast leakage in the middle third, and at the distal end, the latter being directed posteriorly.
The patient underwent surgery, performing a benign transhiatal gastroplasty plus subhiatal gastroplasty, with favorable postoperative evolution, confirming the histological study, the ulceration nature.
