Malignant tracheoesophageal fistula secondary to Hodgkin's disease. Successful surgical treatment with free fascia-muscle graft and left colon bypass.

A case of malignant tracheoesophageal fistula due to Hodgkin's disease at the mediastinum and mid-third of the esophagus is reported. The fistula developed after x-ray therapy (2,000 rads) to the medistinum. In another hospital, she had undergone two unsuccessful attempts to close the fistula surgically with muscle flap grafts, following tracheostomy and feeding gastrostomy. The third operation, performed successfully 2 months later at The Roosevelt Hospital, included division of the esophagus above the fistula with cervical esophagostomy. A free muscle graft was used to close the fistula in the trachea. One month later, subcutaneous antiperistaltic left colon bypass was performed in one stage to connect the cervical esophagus with the lower stomach. At the same time, distal closure of esophagus at the cardia, pyloroplasty, and splenectomy were done. These operations allowed that time, recurrence of the fistula necessitated a fourth operative repair. This time, a 2 inch square piece of fascia and its underlying muscle from the gluteus medius were used to reinforce the closure. The fistula remains closed to date.