TUBERCULOUS FISTULA OF THE ESOPHAGUS

Background. Tuberculous involvement of the esophagus has been extremel y rare during the past 40 years. It will be, however, more frequently encountered in the future, as the number of immunocompromised patients is growing. This condition is usually secondary to infection in other thoracic sites, such as lungs, larynx, or mediastinum. The diagnosis is difficult if the suspicion of tuberculosis is not raised. Dysphagia and cough after ingestion of fluids and food are common symptoms with out any other specific signs in these patients. Diagnosis is based on combination of esophagography, esophagoscopy, bronchoscopy, and comput ed tomographic scan. Methods. We present 3 patients with tuberculous f istulas of the esophagus. Two of our 3 patients were treated successfu lly with the combination of operation and antituberculous chemotherapy . Fistulas were resected and closed directly. Suture lines were secure d with pedicled pleural naps. Results. Both patients who underwent ope ration recovered without complications. One patient died without defin itive diagnosis and treatment. Conclusions. Treatment of tuberculous f istulas consists of operation and antituberculous chemotherapy, althou gh antituberculous medication alone has been suggested to be effective if the diagnosis is early. However, operation is usually necessary to establish the correct diagnosis. Therefore, we believe that if the ca use of the esophageal fistula cannot be verified, thoracotomy should b e performed. If the fistula is left untreated the consequences are usu ally fatal.