A 73-year-old woman presented with a one-week historyof productive cough with foul-smelling sputum with a fecalodor. Three months before the onset of the symptom, shehad been diagnosed with gastric cancer involving the pancreasand descending colon. Unfortunately, chemotherapyachieved no response. Computed tomography (CT) revealeda direct connection between the left lower bronchi and thedescending colon with consolidation in the left lower lobewithout a subdiaphragmatic abscess, suggesting invasivecancerous lesions (Picture). Sputum cultures grew Escherichiacoli, and the cause of the malodor was confirmedto be colobronchial fistula (CBF). CBF is a rare complicationthat is most frequently associated with Crohn’s disease.It is also seen in cases of infection, postoperative adhesionand malignancy (1). Barium enema and CT are useful for itsdiagnosis. Management usually requires surgery and infectioncontrol (2); however, she did not undergo further examinations,including colonoscopy and barium enema, anddeclined surgery because of her poor performance status.She was treated with antibiotics and intravenous infusionwithout taking anything through the oral route. The patientdied within one week.
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