Tracheoesophageal fistulas are uncommon and present diverse etiologies, among which is burning of the esophagus due to caustic ingestion. Herein, we report the case of a 27-year-old male patient having ingested a caustic substance 14 days prior and presenting burning retrosternal pain, weakness, productive cough with purulent sputum and dyspnea accompanied by hoarseness for the preceding 24 h. Endoscopy of the upper digestive tract revealed a tracheoesophageal fistula. Treatment consisted of cervical exclusion of the esophageal transit, together with gastrostomy. Subsequently, the nutrient transit was reconstructed through pharyngocoloplasty. The postoperative evolution was favorable.

Keywords: Tracheoesophageal fistula/etiology; Tracheoesophageal fistula/surgery; Esophageal perforation/chemically induced; Colon/surgery

The authors report the case of a 58 year-old woman with nephrolithiasis, who after being submitted to percutaneous lithotripsy developed xantogranulomatous pyelonephritis, lung abscess and sepsis. Initially, treatment included open drainage of the retroperitoneum, nephrectomy and tubular drainage of the lung abscess and pleural space, through right lateral thoracotomy. Pastereula aerogenes was isolated from both lung and retroperitoneal secretions. To our knowledge, this is the first case of nephrobronchial fistula related with this bacteria in medical literature.

Keywords: Bronchial fistula. Xantogranulomatous pyelonephritis. Lung abscess. Gram-negative bacterial infections. Lithiasis. Kidney.

A pneumonia por Pneumocystis carinii (PPC), que é a infecção oportunista que mais comumente põe em risco a vida de pacientes com síndrome da imunodeficiência adquirida (SIDA), tem sido há bastante tempo associada a outros estados de imunodeficiência. Os relatos iniciais sugeriram que a apresentação clínica da PPC em SIDA difere de sua apresentação em outras situações, embora ambas tenham sofrido modificações nos últimos anos. O objetivo do presente estudo é comparar os achados clínicos e laboratoriais da PPC em SIDA com os de pacientes portadores de PPC sem SIDA. Foram revisados os prontuários médicos de todos os pacientes em nossa instituição que tiveram o diagnóstico confirmado de PPC e SIDA durante o ano de 1994 (17 pacientes) e sem SIDA no período de 1992-1994 (dez pacientes). Quando da apresentação, os pacientes sem SIDA tinham uma duração de sintomas significativamente menor (8,4 ± 7,7 vs 19,5 ± 10,2 dias, p < 0,05), menor PaO2 média a ar ambiente (47 ± 8,2 vs 63 ± 10mmHg, p < 0,05), e mais freqüente infiltrado unilateral no radiograma do tórax (60 vs 6%, p < 0,05). O índice de mortalidade da PPC foi marcadamente maior nos pacientes sem SIDA (40 vs 6%, p < 0,05), e este fato estava associado com retarde no início do tratamento específico nestes pacientes. Devido a seu curso mais agudo, apresentação radiológica atípica e alto índice de mortalidade, concluímos que o diagnóstico de PPC deve ser afastado em pacientes que recebem terapia imunossupressora e que profilaxia anti-PPC deve ser fortemente considerada em pacientes que serão imunossuprimidos.

Keywords: PPC-AIDS. PPC não-AIDS.

The authors report a case of bronchoesophageal fistula found unsuspectedly in bronchoscopy. The radiological findings were compatible and etiologic confirmation was established by histopathological studies.

Keywords: Bronchoesophageal fistula. AIDS.

Tracheoesophageal fistula as a late complication of tracheostomy is rare and its incidence is less than 1%. Nonetheless, it should be known, diagnosed, and promptly treated in order to prevent an unfavorable evolution. The authors report on a 41-year-old female who had had tracheostomy a long time before, due to a cerebrovascular accident. Following hospital discharge, the patient presented acute respiratory insufficiency and it was observed that some material was secreted through the tracheostomy nasogastric probe. Tracheoesophageal fistula was endoscopically diagnosed, the patient was submitted to a tracheoplasty and showed good evolution.

Keywords: Tracheostomy. Tracheal tubes. Intubation. Tracheoesophageal fistula. Intensive care units.

Gastrobronchial fistula is a rare condition as a complication following bariatric surgery. The management of this condition requires the active participation of a pulmonologist, who should be familiar with aspects of the main types of bariatric surgery. Herein, we report the cases of two patients who presented recurrent subphrenic and lung abscess secondary to fistula at the angle of His for an average of 19.5 months. After relaparotomy was unsuccessful, cure was achieved by antibiotic therapy and, more importantly, by stenostomy and endoscopic dilatation, together with the use of clips and fibrin glue in the fistula. These pulmonary complications should not be treated in isolation without a gastrointestinal evaluation since this can result in worsening of the respiratory condition, thus making anesthetic management difficult during endoscopic procedures.

Keywords: Fistula; Lung abscess; Subphrenic abscess; Obesity, surgery; Endoscopy.