ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 5 Number 1 1 of 4 Esophageal Covered Stent Fracture And Perforation In To The Main Left Bronchi I Alfageme, M Merino Citation I Alfageme, M Merino. Esophageal Covered Stent Fracture And Perforation In To The Main Left Bronchi. The Internet Journal of Pulmonary Medicine. 2004 Volume 5 Number 1. Abstract A 56-year old male was diagnosed with esophageal carcinoma and treated with chemotherapy and chemoradiation therapy as palliative therapy. Nineteen months after the diagnosis and eight months after radiotherapy, the patient experienced dysphagia and cough when eating. A fistula was discovered between the esophagus and the main left bronchi in the barium esophagram. A coated self-expanding metal stent (SEMS) was placed into the esophagus as palliative therapy. Four months after the SEMS insertion, the patient was re-admitted again due to dyspnea, cough and expectoration. The fibro-bronchoscope showed a fistula between the main left bronchi and the esophagus with coated SEMS perforation into the bronchi. CASE REPORT A 56-year old male was referred to our hospital by chest pain when eating, and weight loss at the last two months. The barium esophagram discovered a polypoid lesion in the middle third of the esophagus, with a slight stenosis. The oral endoscopy revealed a neoplasic grown and the biopsy taken during the oral endoscopy showed a squamous carcinoma. Infiltration of the main left bronchi was demonstrated in the chest CT-scan and in the eco- endoscopy, without mediastinal adenopathy or metastases. Chemotherapy with six cycles of 5- fluorouracil and cisplatin was done after the diagnosis and chemoradiation therapy (44 Gy) was administrated as palliative therapy. Nineteen months after the diagnosis and eight months after radiotherapy, the patient experienced dysphagia and cough when eating. A fistula was discovered between the esophagus and the main left bronchi in the barium esophagram. A coated self-expanding metal stent (SEMS) Ultraflex (Microvasive/ Boston Scientific Inc.) was placed into the esophagus as palliative therapy. Four months after the SEMS insertion, the patient was re- admitted again due to dyspnea, cough and expectoration. The fibro-bronchoscope showed a fistula between the main left bronchi and the esophagus with coated SEMS perforation into the bronchi (Figure 1). A subsequent SEMS was placed within the pre-existent esophageal stent. The patient died a few days later due to massive hematemesis. Figure 1 Figure 1 and 2: Esophageal-bronchial fistula. Yellow cover of esophageal stent penetrates into the main left bronchi next to neoplasic grown