We present two patients who developed delayed fistulization following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory
corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent
chest pain for 6 months. He developed a tension pneumo-
pericardial tamponade caused by a
fistula between gastric tube and pericardium. He recovered after
sternotomy. The second was born prematurely with type C
esophageal atresia and other malformations. After esophageal anastomosis, he developed a refractory
stricture that was resected
at 10 months. Despite a
fundoplication at 4 years, the recurrent
esophageal stricture required resection at 14 years, accomplished by mobilizing the stomach into the chest through a left thoracoabdominal incision. The postoperative course was complicated by a gastric leak in the chest with
empyema, but the patient recovered and was able to eat. Five years later, he underwent an anterior
spinal fusion to correct a worsening kyphoscoliosis. Postoperatively, he developed an ARDS picture, leakage of air through the
gastrostomy, and a fatal pulmonary
hemorrhage secondary to a gastro-
bronchial fistula. Fistulization from esophageal replacement surgery represents a rare long-term complication that pediatric surgeons need to be aware of.