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June 2, 1978

Treatment of Esophagobronchial Fistula

Author Affiliations

Newton-Wellesley Hospital Newton Lower Falls, Mass

JAMA. 1978;239(22):2338. doi:10.1001/jama.1978.03280490022003

To the Editor.—  It is a surgical axiom, hoary but perhaps worthy of occasional reiteration, that a live kitten is better than a dead lion. A recent article in The Journal (238:2048-2049, 1977) provides a case in point and also argues that the retrospectoscope, if used gently and appropriately, is still our most valuable medical tool. A patient is described in whom the late development of an esophagobronchial fistula complicated spontaneous esophageal rupture. Because of uncontrolled pulmonary sepsis secondary to constant soiling by esophageal secretions, surgery was undertaken. This involved direct repair of a 2-cm distal esophageal tear and resection of the involved left lower lobe— certainly a justifiable and classic approach. Unfortunately, however, the patient did not survive.Therefore, it seems reasonable to suggest an alternative mode of management for such problems—less "surgical" perhaps, less "complete" certainly, but nevertheless fairly effective. I refer to the use of a Celestin

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