Asian Journal of Case Reports in Surgery

Background: Congenital bronchopulmonary foregut malformation (CBPFM) is a rare developmental anomaly involving communication between the foregut and respiratory tract. An oesophageal bronchus occurs when a bronchus arises from the oesophagus rather than the normal tracheobronchial tree.

Case Presentation: A two-month-old female infant had coughing immediately after feeds since birth, followed by intermittent noisy breathing that resolved within 20–30 minutes. There was no history of recurrent fever, aspiration pneumonia, cyanotic spells or loss of consciousness. Initial chest radiography was unremarkable. Upper gastrointestinal endoscopy identified a fistulous opening on the left anterolateral oesophageal wall, raising suspicion of a foregut–respiratory fistula. During surgical exploration, a thick-walled tract measuring approximately 2–3 cm was found connecting the lower oesophagus to the left lower lobe bronchus. The left lower lobe was poorly aerated and lacked communication with the normal bronchial tree, whereas the upper lobe was well aerated and normally connected. These findings supported Type III CBPFM (oesophageal bronchus). The infant underwent left lower lobectomy, division of the fistulous tract and oesophageal repair, with preservation of the upper lobe. Postoperative recovery was uneventful, and the infant was discharged in stable condition.

Conclusion: This case illustrates that a foregut–respiratory communication can be present despite an unremarkable chest radiograph and emphasises the value of endoscopic assessment and intraoperative anatomical evaluation in guiding management.