ESOPHAGOMEDIASTINAL-TRACHEAL/BRONCHIAL FISTULAS IN PATIENTS WITH HIV INFECTION AND TUBERCULOSIS, TREATMENT ABILITIES

Aims:

Tuberculosis in patients with terminal stages of HIV infection is characterized by a tendency to multiple organ damage. Formation of fistula between mediastinal lymph nodes and trachea andor esophagus is one of common complications in patients with tuberculosis of intrathoracic lymph nodes. Surgical treatment of these patients is carried out to isolate the digestive tract and the respiratory system.

Methods:

Data of 11 patients with HIV/Tuberculosis co-infection and esophagomediastinal, esophagotracheal/bronchial fistula was examined in surgical department.

Patients were predominantly male (81,8%), mean age was 31 years (range 22 – 35), mean CD4 lymphocyte cell count < 100 cell per µl (range 12 – 102).

Complete physical, microbiological examination, dynamic esophagogastroscopy and bronchoscopy, (CECT) tomography, contrast esophagography were performed. We applied stenting of esophagus for treatment of esophagomediastinal and esophago-tracheal/bronchial fistulas

Results:

All patients were treated with self-expanding plastic stent, which was placed in esophagus. Control of stent position was applied by esophagography and computer tomography. All patients received TB and HIV therapy. Fistulas closed in 3,5 – 4 months – stent was taken off. In 9 patients this method was effective, fistula had closed and stent was taken off, in 2 patients this method was not effective, we could not reach the closing of fistula, so surgical treatment was used.

Conclusions:

Formation of esophagomediastinal-tracheal/bronchial fistulas is a common complication in tuberculosis of intrathoracic lymph nodes in patients with HIV/Tuberculosis co-infection. Stenting of esophagus is an effective method of treatment for patients with esophagomediastinal-tracheal/bronchial fistula. This method allows to separate esophagus and tracheobronchial tree, reduces the risk of development of aspiration pneumonia, and eliminates need of gastrostomy and esophagostomy. Patients live quality increases, they have possibility of oral administration of TB and HIV therapy.