Mediastinal drain-induced bronchoperitoneal fistula following esophageal perforation: a case report

A bronchoperitoneal fistula is a rare complication that is usually associated with intra-abdominal abscesses. Drain-induced bronchoperitoneal fistula following mediastinal drainage for esophageal perforation has not been previously reported. A 76-year-old man with peritoneal metastasis from advanced gastric cancer developed an esophageal perforation during endoscopic balloon dilation for malignant stricture. Since severe malignant esophageal induration precluded secure endoscopic stent deployment, emergency laparotomy was performed as a palliative strategy, including feeding jejunostomy and mediastinal drain placement. Five weeks postoperatively, computed tomography and contrast studies demonstrated migration of the mediastinal drain with a direct fistulous communication between the bronchus and peritoneal cavity. Prompt repositioning of the drain prevented severe respiratory complications; however, the patient died 2 months later owing to progression of the underlying malignancy. This case highlights that prolonged mediastinal drainage could very rarely result in serious iatrogenic bronchoperitoneal fistula, underscoring the importance of careful monitoring during long-term drainage.