Congenital Bronchoesophageal Fistula in an Adult

We present a rare case of a congenital bronchoesophageal fistula in a 54-year-old woman with a history of poor feeding tolerance since infancy and repeated pulmonary infections. She initially presented with epigastric and right upper quadrant abdominal pain. Her workup included a barium esophagogram that revealed a fistula between her midesophagus and a left lower lobe segmental bronchus. The fistula was divided, a left lower lobe superior segmentectomy was performed, and an intercostal muscle was placed over the esophageal closure. The patient noted an immediate decrease of postprandial coughing. Congenital respiratory esophageal fistulas that are not associated with esophageal atresia may persist into adulthood before they become clinically apparent. The diagnosis should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology.