A fistula between the upper gastrointestinal tract (pharynx, esophagus) and the respiratory tract (trachea or bronchus) can occur in association with a number of conditions.


Nonmalignant conditions:

(1) esophageal chemical burn

(2) tuberculosis

(3) histoplasmosis or other deep fungal infection

(4) syphilis

(5) necrotizing infections in the trachea or esophagus, especially associated with HIV disease

(6) lung abscess

(7) pleural empyema

(8) during intubation

(9) erosion from the cuff of an endotracheal tube, especially if there is a rigid nasogastric tube

(10) following penetrating trauma

(11) following neck, thoracic or esophageal surgery

(12) esophageal diverticulitis

(13) swallowed foreign body


Malignant causes:

(1) lung cancer

(2) pharyngeal or esophageal cancer

(3) tracheal cancer

(4) thyroid cancer

(5) Hodgkin's disease or malignant lymphoma

(6) metastatic carcinoma


In malignant causes the fistula may be due to:

(1) direct tumor growth

(2) effects of chemoradiation

(3) complication of resective surgery


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