Acquired bronchoesophageal fistula: an anesthetic challenge

We report a rare case of acquired esophageal traction diverticulum, associated with tuberculous lymphadenitis leading to benign bronchoesophageal fistula of the right lower lobe bronchus. A 30-year-old male patient was admitted to our hospital with history of pulmonary tuberculosis 2 years back and complaints of cough and choking sensation after swallowing for 1 year. The diagnosis of bronchoesophageal fistula was made by contrast esophagogram and confirmed on computed tomographic scan. He was posted for thoracoscopic ligation of the fistula. Anesthetic management included thoracic epidural and general anesthesia with one-lung ventilation. Preoperative optimization, management of one-lung ventilation, optimum fluid management guided by central venous pressures, excellent analgesia with thoracic epidural, postoperative ICU care, and team efforts were important to make us succeed in this rare case of acquired benign bronchoesophageal fistula.