A patient with tracheoesophageal fistula and esophageal cancer after radiotherapy.

BACKGROUND: A 63-year-old woman presented with dysphagia owing to proximal esophageal stenosis 27 years after she received radiation therapy for Hodgkin disease. She had previously experienced various other complications of this treatment, including myelopathy, hypothyroidism, and cardiomyopathy. INVESTIGATIONS: Medical history and physical examination, pathology and immunohistochemistry, bronchoscopy, esophagogastroscopy, chest and abdominal PET-CT scan, examination of the thorax during open right thoracotomy. DIAGNOSIS: Large tracheoesophageal fistula and poorly differentiated squamous cell carcinoma of the esophagus. MANAGEMENT: The stenosis was treated with endoscopic dilatations and brachytherapy, but persisted and became a tracheoesophageal fistula despite repeated placement of esophageal stents. Definitive surgical treatment comprised combined transabdominal and thoracic esophagectomy with creation of a gastric tube and cervical esophagogastrostomy, and repair of the trachea with a pericardial patch and intercostal muscle flap.