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<p>Esophagorespiratory fistula is associated with a poor prognosis in patients with esophageal cancer, which may cause lung abscess and respiratory deterioration. Here, we report our experience when facing challenges in managing a case of advanced esophageal cancer with esophagorespiratory fistula complicated by a large lung abscess. A woman in her 60s visited a nearby clinic complaining of fever and cough. She was initially diagnosed with lung abscess and treated with oral antibiotics. However, because of a poor clinical response, she was referred to our hospital for further examination and treatment. Computed tomography (CT) revealed an esophageal tumor with multiple mediastinal lymphadenopathies and mediastinal emphysema. She was suspected of having esophageal cancer, and upper gastrointestinal endoscopy and esophagography revealed a circumferential Type 3 tumor lesion extending 28–38&#xa0;cm from the incisors, with fistula formation in the lung abscess. We inserted a double-elemental diet tube for drainage and enteral feeding, followed by CT-guided drainage of the lung abscess and placement of an esophageal stent. The inflammatory marker levels improved, and she was able to resume oral intake and was discharged. Subsequently, chemoimmunotherapy with 5-fluorouracil, cisplatin, and pembrolizumab was initiated. However, before starting the second chemotherapy course, the elevation of inflammatory markers was remarkable, and CT revealed reoccurrence of fistulas. The fistula was likely caused by shrinkage of the primary lesion. Despite intensive treatment, the patient’s general condition deteriorated because of airway obstruction caused by progressive lymphadenopathy, and she died 4&#xa0;months after the initial presentation.</p>

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A case of advanced esophageal cancer with esophagorespiratory fistula complicated by lung abscess

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Ayako Shimada,
  • Hajime Higuchi,
  • Takashi Oyama,
  • Yuki Hirano,
  • Yutaka Sugawara,
  • Eri Mannoji,
  • Momoko Kobayashi,
  • Hironobu Wada,
  • Shigetoshi Yoshida,
  • Masahiro Shinoda,
  • Osamu Itano

摘要

Esophagorespiratory fistula is associated with a poor prognosis in patients with esophageal cancer, which may cause lung abscess and respiratory deterioration. Here, we report our experience when facing challenges in managing a case of advanced esophageal cancer with esophagorespiratory fistula complicated by a large lung abscess. A woman in her 60s visited a nearby clinic complaining of fever and cough. She was initially diagnosed with lung abscess and treated with oral antibiotics. However, because of a poor clinical response, she was referred to our hospital for further examination and treatment. Computed tomography (CT) revealed an esophageal tumor with multiple mediastinal lymphadenopathies and mediastinal emphysema. She was suspected of having esophageal cancer, and upper gastrointestinal endoscopy and esophagography revealed a circumferential Type 3 tumor lesion extending 28–38 cm from the incisors, with fistula formation in the lung abscess. We inserted a double-elemental diet tube for drainage and enteral feeding, followed by CT-guided drainage of the lung abscess and placement of an esophageal stent. The inflammatory marker levels improved, and she was able to resume oral intake and was discharged. Subsequently, chemoimmunotherapy with 5-fluorouracil, cisplatin, and pembrolizumab was initiated. However, before starting the second chemotherapy course, the elevation of inflammatory markers was remarkable, and CT revealed reoccurrence of fistulas. The fistula was likely caused by shrinkage of the primary lesion. Despite intensive treatment, the patient’s general condition deteriorated because of airway obstruction caused by progressive lymphadenopathy, and she died 4 months after the initial presentation.