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Chest CT scan (a) and bronchoscopy (b) shows a TEF (size = 1 cm) at the membranous portion of the carina (arrow)
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Chest CT scan revealed a TEF between the mid-esophagus and the tracheal carina, and bronchoscopy demonstrated a fistula 1 cm in diameter located at the membranous portion of the carina (Fig. 1).
The esophagus dilated focally with a large diverticulum communicating directly with the carina without having a defined tract
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After retrieving the tracheobronchial stent, further treatment was attempted through the use of metallic coils and cyanoacrylate glue (n-butyl cyanoacrylate [NBCA], Histoacryl-Blue, Braun, Melsungen, Germany), but these measures were also unsuccessful because the esophagus had dilated focally with a large diverticulum communicating directly with the carina without having a defined tract (Fig. 2).
Modified Y-shaped silicon stent with a longitudinal center cut (a) and bare metallic stent (b). Bare metallic stents are placed in the silicone stent to expand its lumen (c). Bronchoscopy shows the modified Y-shaped silicon stent over an expanded bare metallic stent, which covers the fistula at the level of the carina (d)
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Next, two bare metallic stents were placed within the tube stent to expand its lumen (Fig. 3).