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Abstract
A 73-year-old woman presented with a one-week history of productive cough with foul-smelling
sputum with a fecal odor. Three months before the onset of the symptom, she had been
diagnosed with gastric cancer involving the pancreas and descending colon. Unfortunately,
chemotherapy achieved no response. Computed tomography (CT) revealed a direct connection
between the left lower bronchi and the descending colon with consolidation in the
left lower lobe without a subdiaphragmatic abscess, suggesting invasive cancerous
lesions (Picture). Sputum cultures grew Escherichia coli, and the cause of the malodor
was confirmed to be colobronchial fistula (CBF). CBF is a rare complication that is
most frequently associated with Crohn's disease. It is also seen in cases of infection,
postoperative adhesion and malignancy (1). Barium enema and CT are useful for its
diagnosis. Management usually requires surgery and infection control (2); however,
she did not undergo further examinations, including colonoscopy and barium enema,
and declined surgery because of her poor performance status. She was treated with
antibiotics and intravenous infusion without taking anything through the oral route.
The patient died within one week.
Picture.
The authors state that they have no Conflict of Interest (COI).
Colobronchial fistula (CBF) is rare and easy to be delayed in clinic. There is no systemic study about this disease. The pathogenesis, clinical presentations, diagnosis and treatment of CBF were analyzed in this study.
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