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Lian BD, Zhou WY, Peng J, Zhang X, Zhao K, Chen C, Wang XT, Wang YG, He ZL. Bronchobiliary fistula caused after percutaneous transhepatic biliary drainage treatment: A case report. Medicine (Baltimore) 2023; 102:e36363. [PMID: 38115309 PMCID: PMC10727582 DOI: 10.1097/md.0000000000036363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Percutaneous transhepatic biliary drainage (PTBD) plays a significant role especially in the diagnosis and decompression of bile duct obstruction. However, it is associated with complications such as hemobilia, occlusion of drainage, bile leakage, and even bronchobiliary fistula (BBF). PATIENT CONCERNS AND DIAGNOSES We herein describe a patient with a complication of BBF caused by long-term indwelling PTBD catheters. She underwent multiple operations including bilioenteric anastomosis, hepatic left lateral lobectomy, and long-term PTBD treatment. Her symptoms were mainly cough, fever, and yellow sputum and her diagnosis was confirmed by sputum culture (bilirubin detection was positive). INTERVENTIONS AND OUTCOMES The patient recovered uneventfully by minimally invasive treatment, was discharged after 1 week of hospitalization, and the drainage tube was removed 2 weeks later. During 2 years of follow-up, no recurrence of BBF was observed. LESSONS Patients with long-term indwelling PTBD catheters for biliary tract obstruction may lead to BBF. The treatment plan of BBF is tailored to the patient's individualized characteristics. And minimally invasive treatments might be an effective alternate way for the treatment of BBF. The accurate diagnosis, precision treatment, and multidisciplinary team play important roles in the treatment of BBF.
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Affiliation(s)
- Bo-Da Lian
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Wen-Yi Zhou
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Jiang Peng
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xin Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Kang Zhao
- Department of Ultrasound Interventional, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Chen Chen
- Department of Ultrasound Interventional, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xin-Tian Wang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Yong-Gang Wang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Zi-Li He
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
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Batalin Júnior LM, Zandoná MCESS, Vargas TA, de Oliveira JC, Chiappetto JRS, Oliveira CV, Romeiro FG, Tanni SE. Case report: Biliobronchial fistula after biliary tract stenosis. Front Med (Lausanne) 2022; 9:1075745. [PMID: 36590971 PMCID: PMC9800597 DOI: 10.3389/fmed.2022.1075745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Biliobronchial fistula (BBF) is a rare abnormality resulting from congenital or acquired communication between the bile ducts and the bronchial tree. Patients often suffer from chronic cough, dyspnea, and bilioptysis, a pathognomonic symptom of this condition. Conservative methods such as less-invasive procedures are gradually consolidating. Nonetheless, surgery remains the primary treatment, especially in more complex cases. We present the case of a 44-year-old woman with a chronic cough, no verified periods of fever, cyclic jaundice, and episodes of yellowish sputum. She had undergone cholecystectomy in 2018 and had been hospitalized several times since for pneumonia treatment. All consequent investigations for mycobacteriosis were negative. When referred to our hospital, she had cyclic jaundice and parenchymal consolidation in the right lower lobe. Suspected bilioptysis motivated the search for a biliobronchial fistula. Magnetic resonance cholangiography (MRC) confirmed stenosis of the biliary tract and fistulous path, and sputum analysis indicated high bilirubin levels. External biliary bypass was performed as an initial conservative and definitive therapy due to the presence of liver cirrhosis. Although BBF is a rare condition when bilioptysis is suspected, a diagnostic investigation should be initiated. Our case study proposes two criteria for diagnosis: an imaging exam demonstrating the fistulous path and confirmation of bilirubin in the sputum or bronchoalveolar lavage (BAL). When diagnosed, surgical correction should be performed.
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Affiliation(s)
- Luís Maurício Batalin Júnior
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,*Correspondence: Luís Maurício Batalin Júnior
| | - Mariana Conceição e Silva Seleme Zandoná
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Thomaz Almeida Vargas
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Julio Cesar de Oliveira
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Juliana Rocha Souza Chiappetto
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Cassio Vieira Oliveira
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Fernando Gomes Romeiro
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil
| | - Suzana Erico Tanni
- Pulmonary Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Gastroenterology Division of Internal Medicine, Botucatu School of Medicine—UNESP, São Paulo, Brazil,Suzana Erico Tanni
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