Airway-esophageal fistula

An airway-esophageal fistula is a communication between the esophagus and either the trachea or a main-stem bronchus. They have been reported uncommonly in the dog and cat as either congenital or acquired conditions.^48-51 Acquired airway- esophageal fistulae most commonly develop secondary to for­eign body penetration of the esophagus.⁵⁰ Congenital airway- esophageal fistulae have been proposed, with Cairn terriers being possibly predisposed.^49,50 The most common clinical sign is coughing or dyspnea after eating or drinking.⁴⁹ Other clinical signs include regurgitation and anorexia, fever, or leth­argy, with some of these signs being related to aspiration pneu­monia.

The results of a minimum diagnostic database typically show leukocytosis with or without a left shift secondary to pneu­monia. Survey radiographs may reveal a radiopaque foreign body. However, the foreign body may have already dislodged, and pneumonia may be the only abnormality noted. A defini­tive diagnosis requires a contrast esophagram, which may show the communication between the esophagus and the airway. It is recommended to use a small amount of barium for the study since iodinated contrast agents are hyperosmolar and may cause pulmonary edema if they reach the airway.^17,49-51 Endo­scopy and bronchoscopy may be used as adjunct diagnostic tools.⁵⁰

Treatment requires surgical correction. Lung lobectomy is usually necessary along with repair of the esophageal wall de­fect.^49,50 The prognosis for a full recovery is good if the animal survives the surgical procedure.

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