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1
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El Ouali IIE, El Graini SSE, El Aoufir OOE, Belaabed SSB, Benkabbou AAB, Amrani LLA, Bakkar MMB, Omor YYO, Lahnaoui OOL, Amalik SSA. Broncho biliary fistula, a rare complication after hepatectomy: case report of endoscopic and radiological management. J Surg Case Rep 2024; 2024:rjae657. [PMID: 39430597 PMCID: PMC11491166 DOI: 10.1093/jscr/rjae657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 10/05/2024] [Indexed: 10/22/2024] Open
Abstract
Bronchobiliary fistula (BBF) is one of the most exceptional complications following hepatic surgery. By integrating evidence-based case studies from existing literature, this review offers critical insights into the efficacy of diverse imaging modalities and therapeutic approaches across a broad spectrum of clinical scenarios. Computed tomography, and magnetic resonance cholangiography or even scintigraphy shows an abnormal tractus between biliary ducts and pulmonary bronchi and minimally invasive techniques using endoscopy are considered the techniques of choice. Surgery should only be considered in complicated cases due to significant morbidity and mortality rate. We report the case of a 46-year-old man with metastatic adenocarcinoma of the rectum involving the liver, treated with metastasectomy, which was complicated by a BBF. The patient underwent radiological external drainage followed by endoscopic placement of biliary endoprosthesis with favorable outcome.
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Affiliation(s)
- Ibtissam I E El Ouali
- Radiology Department, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Soumiya S E El Graini
- Radiology Department, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Omar O E El Aoufir
- Faculty of Medicine and Pharmacy of Rabat, Anatomy Department, Imp. Souissi, Rabat 10100, Morocco
| | - Soufya S B Belaabed
- Radiology Department, Ibn Sina University Hospital, Avenue Bettouga, Rabat, BP 6527, Morocco
| | - Amine A B Benkabbou
- Department of General Surgery, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Laila L A Amrani
- Department of Gastroentrology, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Meriem M B Bakkar
- Department of Gastroentrology, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Youssef Y O Omor
- Radiology Department, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Oumaima O L Lahnaoui
- Department of General Surgery, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
| | - Sanae S A Amalik
- Radiology Department, National Institute of Oncology, Av. Allal Al Fassi, Rabat, BP 6024, Morocco
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2
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Queirós T, Castro B, Ferreira A, Amado A, Louro H, Lucas MC, Santos J, Cardoso JM, Oliveira M. Bronchobiliary fistula after stenting of biliary duct as the management of iatrogenic bile duct injury during elective cholecystectomy. Acta Chir Belg 2023; 123:544-549. [PMID: 35253620 DOI: 10.1080/00015458.2022.2049071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Bronchobiliary fistula is a rare and complex entity defined by an abnormal communication between the biliary and bronchial systems. The etiopathogenesis is not completely understood, but the most common factors implicated are hepatobiliary tumors, biliary obstruction, iatrogenic damage or trauma. METHODS Here we present a case of a 69-year-old man that developed a bronchobiliary fistula and a pulmonary abscess after migration of a bile duct stent placed as part of the treatment of an iatrogenic bile duct injury that occurred during elective cholecystectomy. RESULTS A conservative approach, that included broad-spectrum antibiotic, removal of the stent, and sphincterotomy, was enough for the closure of the fistula and resolution of the symptoms. CONCLUSION We emphasize the importance of prompt recognition of this entity and a concerted therapeutic strategy to optimize the probability of success, avoiding the destructive consequences of the bile in the pulmonary parenchyma and septic complications.
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Affiliation(s)
- Tatiana Queirós
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Bárbara Castro
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Ana Ferreira
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Andreia Amado
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Hugo Louro
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Maria Conceição Lucas
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Jorge Santos
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - João Miguel Cardoso
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Manuel Oliveira
- General Surgery Department, Centro Hospitalar de Vila Nova de Gaia Espinho, EPE, Vila Nova de Gaia, Portugal
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3
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Percutaneous Treatment of Bronchobiliary Fistula: Report of a Successful Transhepatic Embolization and a Decision-Making Strategy Driven by Systematic Literature Review. Cardiovasc Intervent Radiol 2021; 44:1005-1016. [PMID: 33928407 DOI: 10.1007/s00270-021-02837-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
Bronchobiliary fistula is a rare condition characterized by bile leaking into the bronchial tree causing biliptysis. It may arise from liver infection or as a consequence of resection and thermal ablation of cancer. Currently, there is no consensus about the treatment strategy. Surgery is considered the main therapy by most authors. However, this systematic literature review shows that the success rate of percutaneous treatments may reach 75%. Adding to such evidence, we also report the case of a woman affected by iatrogenic bronchobiliary fistula secondary to liver thermal ablation, successfully treated with percutaneous drainage plus embolization. Summarizing these results, we encourage the percutaneous management of bronchobiliary fistula by providing a 3-step decision-making algorithm, aimed at reducing the need for major surgery.
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4
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Takakusagi S, Hoshino T, Takagi H, Naganuma A, Yokoyama Y, Kizawa K, Marubashi K, Kosone T, Watanabe A, Kubo N, Araki K, Harimoto N, Shirabe K, Nobusawa S, Zennyoji D, Shimizu T, Sato K, Kakizaki S, Uraoka T. The development of broncho-biliary fistula after treatment for hepatocellular carcinoma: a report of two cases. Clin J Gastroenterol 2021; 14:229-237. [PMID: 33099725 DOI: 10.1007/s12328-020-01264-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Broncho-biliary fistula (BBF) is a rare but severe disorder defined as abnormal communication between the biliary system and bronchial tree. Cases of BBF have occasionally been reported, but no standard treatment has been established. We report two cases of BBF that developed after the treatment of hepatocellular carcinoma (HCC) and reviewed the relevant literature. Case 1, a man in his early eighties was diagnosed with BBF 4 months after undergoing surgical resection for HCC (diameter, 7 cm; location, segments 4 and 5). Percutaneous drainage and endoscopic nasobiliary drainage (ENBD) improved BBF without recurrence for more than a year. Case 2, a woman in her late sixties was diagnosed with BBF after percutaneous radiofrequency ablation for HCC. Although the BBF was treated with ENBD, bronchial occlusion, and percutaneous transhepatic portal vein embolization, these treatments were unsuccessful and the patient died. Although non-invasive treatments have been developed, refractory BBF still exists. The prediction of BBF and the development of more effective treatments are necessary to improve outcomes.
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Affiliation(s)
- Satoshi Takakusagi
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Hitoshi Takagi
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan.
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan
| | - Yozo Yokoyama
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Kazuko Kizawa
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Kyoko Marubashi
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Takashi Kosone
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Akira Watanabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norifumi Harimoto
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Dan Zennyoji
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takehiro Shimizu
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Abstract
Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence of bile in the sputum as pathognomonic symptom, and it is often associated with suspicious pneumonia. The most common causes include infections (e.g. echinococcosis), hepatobiliary surgery, blunt torso traumas, tumors and percutaneous transhepatic procedures. Opinions about BBF treatment are still controversial as it can be treated by both conservative and surgical procedures, while pharmacological treatments are only rarely used. This case report presents a patient who had been diagnosed with chronic BBF of unknown cause, underwent several ineffective conservative procedures and was at last surgically treated.
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Affiliation(s)
- Marzia Acquasanta
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Gaia Spadarella
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
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Huang ZM, Zuo MX, Gu YK, Lai CX, Pan QX, Yi XC, Zhang TQ, Huang JH. Bronchobiliary fistula after ablation of hepatocellular carcinoma adjacent to the diaphragm: Case report and literature review. Thorac Cancer 2020; 11:1233-1238. [PMID: 32147969 PMCID: PMC7180580 DOI: 10.1111/1759-7714.13380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background Bronchobiliary fistula is a rare, but life‐threatening complication after ablation of hepatocellular carcinoma. Few cases of bronchobiliary fistula have been reported and the treatment is controversial. Methods From 2006 to 2019, a total of 11 patients were diagnosed with bronchobiliary fistula after ablation and received nonsurgical treatment. Results All 11 patients presented with cough and bilioptysis. There were only two patients in which MRI revealed an obvious fistulous tract connecting the pleural effusion and biliary lesions. Pleural effusion, liver abscess and hepatic biloma were found in other patients. Three patients died of uncontrolled bronchobiliary fistula. Conclusions Bronchobiliary fistula is a rare post‐ablation complication but should be taken into consideration in clinical decisions. Minimally invasive interventional treatment is a relatively effective means of dealing with bronchobiliary fistula, but as for the more severe cases, greater clinical experience is required.
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Affiliation(s)
- Zhi-Mei Huang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Meng-Xuan Zuo
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yang-Kui Gu
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chun-Xiao Lai
- Department of Gastroenterology, Huangpu People's Hospital, Zhongshan, China
| | - Qiu-Xiang Pan
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Cheng Yi
- Department of Medical Oncology, TCM Hospital of Ruichang, Ruichang, China
| | - Tian-Qi Zhang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jin-Hua Huang
- Department of Minimal invasive intervention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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7
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Abstract
Abstract
Background
Biliptysis means coughing of bile which is a presenting symptom of a rare condition called bronchobiliary fistula (BBF). BBF is a connection between the biliary tract and bronchial tree. BBF mostly occurs secondary to malignancy, liver abscess, and trauma. Surgical approach in BBF management was the main management strategy, then endoscopic approach.
Case presentation
We managed our first encountered case of biliptysis endoscopically by endoscopic retrograde cholangiopancreatography (ERCP).
Conclusion
ERCP management seems to be effective in management of biliptysis.
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8
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Lazarou V, Moris D, Papalampros A, Tsilimigras DI, Karachaliou GS, Petrou A. Bronchobiliary fistula after hepatectomy: A case report and review of the literature. Mol Clin Oncol 2019; 11:602-606. [PMID: 31798877 PMCID: PMC6870047 DOI: 10.3892/mco.2019.1935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
Bronchobiliary fistula (BBF) is a rare complication following hepatectomy, and consists of an abnormal intercommunication between the biliary tract and bronchial tree. The management of this rare entity is challenging with limited current evidence to date on how to treat this condition. Herein, a case of BBF following a central hepatectomy and the successive steps of the management was presented. Fourteen months postoperatively, the patient presented to the Oncology Department complaining of new onset fever and expectoration. A computerized tomography scan revealed a BBF and the patient was subsequently referred to our department for further treatment. The surgical team decided that a further operation was required. Using the transabdominal approach, a communication between the initial intrahepatic collection and one inferior lobular bronchus was revealed. Transhiatal removal of fistula was performed with closure of the defect through the abdomen. There was no bile leak through the remaining liver parenchyma. Multidisciplinary management should be considered, taking into consideration the underlying pathology leading to this rare complication. Conservative treatment should be considered first, while surgical resection of the BBF remains an option when other therapies have failed. Surgeons should be aware of this rare complication bile duct injuries during hepatic operations can cause.
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Affiliation(s)
- Vasiliki Lazarou
- Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Nicosia 2029, Cyprus
| | - Dimitrios Moris
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens 11527, Greece
| | - Alexandros Papalampros
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens 11527, Greece
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Laikon General Hospital, University of Athens, Athens 11527, Greece
| | | | - Athanasios Petrou
- Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Nicosia 2029, Cyprus
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9
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Elbahr O. Biliptysis. EGYPTIAN LIVER JOURNAL 2019; 9:4. [DOI: https:/doi.org/10.1186/s43066-019-0005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/16/2019] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Biliptysis means coughing of bile which is a presenting symptom of a rare condition called bronchobiliary fistula (BBF). BBF is a connection between the biliary tract and bronchial tree. BBF mostly occurs secondary to malignancy, liver abscess, and trauma. Surgical approach in BBF management was the main management strategy, then endoscopic approach.
Case presentation
We managed our first encountered case of biliptysis endoscopically by endoscopic retrograde cholangiopancreatography (ERCP).
Conclusion
ERCP management seems to be effective in management of biliptysis.
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10
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Abelleira R, Toubes ME, Alegría AMD, Valdés L. Late biliobronchial fistula. Pulmonology 2018; 24:317-320. [DOI: 10.1016/j.pulmoe.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/04/2018] [Indexed: 11/25/2022] Open
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11
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Nassar Y, Hida S, Richter S. A Biliobronchial Fistula in a Patient With Hepatocellcular Carcinoma Treated With Chemoembolization Diagnosed by Hepatobiliary Iminodiacetic Acid Scan and Managed by Endoscopic Retrograde Cholangiopancreatography. Gastroenterology Res 2018; 10:383-385. [PMID: 29317950 PMCID: PMC5755644 DOI: 10.14740/gr904w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 01/13/2023] Open
Abstract
A biliobronchial fistula is an abnormal communication between the biliary tract and the bronchial tree. It may be a rare complication after treatment of hepatocellular carcinoma with transcatheter arterial chemoembolization (TACE). We present a case of a 71-year-old man that developed a biliobronchial fistula as a complication of hepatocellular carcinoma treated with TACE. It was successfully diagnosed by hepatobiliary iminodiacetic acid (HIDA) scan and treated with endoscopic retrograde pancreatography.
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Affiliation(s)
| | - Sven Hida
- Albany Medical Center, Albany, NY, USA
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12
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Dahiya D, Kaman L, Behera A. Biliopleural fistula following gun shot injury in right axilla. BMJ Case Rep 2015; 2015:bcr-2014-207454. [PMID: 25666247 DOI: 10.1136/bcr-2014-207454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A biliopleural fistula (BPF) is a rare and atypical manifestation of thoracoabdominal trauma. A stepwise approach for the management is recommended for a successful outcome. We report a case of a 22-year-old man who was referred to our hospital with respiratory discomfort after sustaining a gunshot injury in the right axilla. On investigations he had haemopneumothorax, central liver contusion with perihepatic fluid and a bullet lodged at the level of right renal hilum. He was at first managed by placing a right intercostal tube drain, which initially drained blood and subsequently started draining bile. He was managed successfully with endoscopic biliary stenting, pigtail drainage of subphrenic collection and antibiotics.
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Affiliation(s)
- Divya Dahiya
- Department of General Surgery, PGIMER, Chandigarh, India
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13
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Thoracobiliary fistulas: literature review and a case report of fistula closure with omentum majus. Radiol Oncol 2013; 47:77-85. [PMID: 23450657 PMCID: PMC3573838 DOI: 10.2478/raon-2013-0003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/30/2012] [Indexed: 02/08/2023] Open
Abstract
Background Thoracobiliary fistulas are pathological communications between the biliary tract and the bronchial tree (bronchobiliary fistulas) or the biliary tract and the pleural space (pleurobiliary fistulas). Review of the literature We have reviewed aetiology, pathogenesis, predilection formation points, the clinical picture, diagnostic possibilities, and therapeutic options for thoracobiliary fistulas. Case report A patient with an iatrogenic bronchobiliary fistula which developed after radiofrequency ablation of a colorectal carcinoma metastasis of the liver is present. We also describe the closure of the bronchobiliary fistula with the greater omentum as a possible manner of fistula closure, which was not reported previously according to the knowledge of the authors. Conclusions Newer papers report of successful non-surgical therapy, although the bulk of the literature advocates surgical therapy. Fistula closure with the greater omentum is a possible method of the thoracobiliary fistula treatment.
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14
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Jung GO, Park DE. Successful percutaneous management of bronchobiliary fistula after radiofrequency ablation of metastatic cholangiocarcinoma in a patient who has a postoperative stricture of hepaticojejunostomy site. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:110-4. [PMID: 26388918 PMCID: PMC4575004 DOI: 10.14701/kjhbps.2012.16.3.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 07/30/2012] [Accepted: 08/02/2012] [Indexed: 11/17/2022]
Abstract
Bronchobiliary fistula (BBF) is a rare condition that is defined as an abnormal communication between the biliary system and bronchial tree. Furthermore, a BBF is an extremely rare complication of radiofrequency ablation (RFA). A 54 year-old man with a history of extrahepatic biliary cancer had been suffering with a benign stricture of hepaticojejunostomy site and was treated with RFA for metastatic cholangicarcinoma. In this report, we describe a patient with BBF complicated by an abscess which occurred after RFA. He was treated by placement of external drainage catheter into the liver abscess and percutaneous transhepatic biliary drainage (PTBD) into the right intrahepatic duct. After 6 weeks, a complete obliteration of the BBF was confirmed by a repeated follow-up of computed tomography scan and cholangiography through PTBD.
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Affiliation(s)
- Gum O Jung
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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15
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Biliobronchial fistula after liver surgery for giant hydatid cyst. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2011; 2011:347654. [PMID: 21960731 PMCID: PMC3179881 DOI: 10.1155/2011/347654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 04/23/2011] [Accepted: 07/28/2011] [Indexed: 11/20/2022]
Abstract
Background.
Biliobronchial fistula (BBF) is a rare
complication in the natural history of liver
hydatid disease by Echinococcus
granulosus. We present a case of BBF
after resection of a giant liver hydatid cyst in
a 72-year-old woman. Case
Report. A total cystpericystectomy was
done, leaving the left lateral section of the
liver that was fixed to the diaphragm.
Postoperatively, the patient developed
obstructive jaundice. An ERCP showed an
obstruction at the junction of the left biliary
duct and the main biliary duct and contrast
leak. At reoperation, the main duct was ischemic,
likely due to torsion along its longitudinal
axis. A hepatotomy was done at the hilar plate,
and the biliary duct was dissected and
anastomosed to a Roux-en-Y jejunal loop. She was
discharged without complications. Five months
later, the patient developed cholangitis and was
successfully treated with antibiotics. However,
she suffered repeated respiratory infections, and
four months later she was admitted to the
hospital with fever, cough, bilioptysis, and
right lower lobe pneumonia. The diagnosis of BBF
was confirmed with 99mTc Mebrofenin
scintigraphy. At transhepatic cholangiography,
bile duct dilation was seen, with a
biliothoracic leak. She underwent dilatation
of cholangiojejunostomy stricture with
placement of an external-internal catheter. The
catheter was removed 3.5 months later, and two
years later the patient remains in very good
condition. Conclusion. An
indirect treatment of the BBF by percutaneous
transhepatic dilation of the biliary stenosis
avoided a more invasive treatment, with
satisfactory outcome.
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Liao GQ, Wang H, Zhu GY, Zhu KB, Lv FX, Tai S. Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years. World J Gastroenterol 2011; 17:3842-9. [PMID: 21987628 PMCID: PMC3181447 DOI: 10.3748/wjg.v17.i33.3842] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 01/22/2011] [Accepted: 01/29/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF).
METHODS: Literature searches were performed in Medline, EMBASE, PHMC and LWW (January 1980-August 2010) using the following keywords: biliobronchial fistula, bronchobiliary fistula, broncho-biliary fistula, biliary-bronchial fistula, tracheobiliary fistula, hepatobronchial fistula, bronchopleural fistula, and biliptysis. Further articles were identified through cross-referencing.
RESULTS: Sixty-eight cases were collected and reviewed. BBF secondary to tumors (32.3%, 22/68), including primary tumors (19.1%, 13/68) and hepatic metastases (13.2%, 9/68), shared the largest proportion of all cases. Biliptysis was found in all patients, and other symptoms were respiratory symptoms, such as irritating cough, fever (36/68) and jaundice (20/68). Half of the patients were treated by less-invasive methods such as endoscopic retrograde biliary drainage. Invasive approaches like surgery were used less frequently (41.7%, 28/67). The outcome was good at the end of the follow-up period in 28 cases (range, 2 wk to 72 mo), and the recovery rate was 87.7% (57/65).
CONCLUSION: The clinical diagnosis of BBF can be established by sputum analysis. Careful assessment of this condition is needed before therapeutic procedure. Invasive approaches should be considered only when non-invasive methods failed.
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-267. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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Schuld J, Justinger C, Wagner M, Bohle RM, Kollmar O, Schilling MK, Richter S. Bronchobiliary fistula: a rare complication of hepatic endometriosis. Fertil Steril 2011; 95:804.e15-8. [PMID: 20817157 DOI: 10.1016/j.fertnstert.2010.07.1087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/20/2010] [Accepted: 07/23/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To report the case and surgical therapy of a patient with bilioptysis after vaginal delivery, caused by bronchobiliary fistula. Histologic analysis revealed endometrial glands embedded in the decidual stroma neighboring the liver and the lung. DESIGN Case report. SETTING University hospital. PATIENT(S) A 39-year-old patient, 7 days after vaginal delivery, without endometrial history. INTERVENTION(S) Synchronous liver and lung resection of a bronchobiliary fistula by laparotomy and a transdiaphragmatic approach. MAIN OUTCOME MEASURE(S) For complicated brochobiliary fistula caused by endometriosis, radical surgical treatment is mandatory. RESULT(S) Histopathologic analyses confirmed the presence of clusters of endometrial glands embedded in the decidual stroma that were neighboring the liver, and perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives. CONCLUSION(S) Hepatic and perihepatic endometriosis can cause a bronchobiliary fistula. Exacerbation of the symptoms can be triggered by high estrogen levels, physiologically dominating the last trimester. For such a rare case, surgery is mandatory.
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Affiliation(s)
- Jochen Schuld
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany
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Petrolati A, Pacella CM, Nasoni S, Rossi Z, Altavilla N, Cipolla R, Fenderico P, Forlini G, Stasi R. Management of biliobronchial fistula with octreotide: a case report. Am J Gastroenterol 2009; 104:2638-9. [PMID: 19806104 DOI: 10.1038/ajg.2009.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bronchobiliary fistula in a cirrhotic patient: a case report and review of the literature. Am J Med Sci 2008; 335:315-9. [PMID: 18414073 DOI: 10.1097/maj.0b013e31812e9633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bronchobiliary fistula is defined as the passage of bile in the bronchi. The presence of bronchobiliary fistula in patient with cirrhosis is extremely rare. Management of these fistulas is often very difficult and can be associated with high morbidity and mortality. We are presenting a patient with ethanol related cirrhosis and biliptysis in whom a diagnosis of bronchobiliary fistula was made. A review of the literature including diagnosis and management is performed.
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Tran T, Hampel H, Qureshi WA, Shaib Y. Successful endoscopic management of bronchobiliary fistula due to radiofrequency ablation. Dig Dis Sci 2007; 52:3178-80. [PMID: 17638080 DOI: 10.1007/s10620-006-9331-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 03/22/2006] [Indexed: 02/06/2023]
Affiliation(s)
- Thomas Tran
- Section of Gastroenterology, The Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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Lee MT, Hsi SC, Hu P, Liu KY. Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage. World J Gastroenterol 2007; 13:3268-70. [PMID: 17589912 PMCID: PMC4436619 DOI: 10.3748/wjg.v13.i23.3268] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.
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Affiliation(s)
- Ming-Tsung Lee
- Division of General Surgery, Department of Surgery, Armed Forces Taoyuan General Hospital, No.168 Chung-Shin Rd, Taoyuan, Taiwan, China
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