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Murugesan C, Bai M, Pottakkat B, Dwivedi DP, Munuswamy H, Mohan P. Congenital bilio-bronchial fistula in an adult: a review of literature and video demonstration of laparoscopic fistula tract excision. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:1-11. [PMID: 38494180 PMCID: PMC10961235 DOI: 10.7602/jmis.2024.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 03/19/2024]
Abstract
This article presents a review of the literature on congenital bilio-bronchial fistula (BBF), a rare anomaly characterized by abnormal communication between the bile duct and respiratory tract. Congenital BBF often presents with bilioptysis in early neonates and infants; however, patients with no overt symptoms may occasionally present in adulthood. Our literature search in Medline from 1850 to 2023 revealed 42 reported cases of congenital BBF, primarily managed with thoracotomy and excision of the fistula tract. About one-third of these cases required multiple surgeries due to associated biliary anomalies. The review underscores the importance of diagnostic imaging, including bronchoscopy, in identifying and delineating the extent of the fistula. It also highlights the evolving surgical management, with recent cases showing the efficacy of minimally invasive approaches such as laparoscopy and thoracoscopy. In addition to the literature review, we report a young female patient with a history of recurrent respiratory infections presenting with bilioptysis and extensive left lung damage. Initial management included bronchoscopy-guided glue instillation, left thoracotomy, and pneumonectomy. Following the recurrence of symptoms, the patient was successfully treated with laparoscopic excision of the fistula tract. In recent times, minimally invasive approaches such as laparoscopy and thoracoscopy, with excision of the fistula tract are gaining popularity and have shown good results. We suggest biliary communication being the high-pressure end, tackling it transabdominal may prevent recurrent problems.
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Affiliation(s)
- Chandrasekar Murugesan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muniza Bai
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hemachandren Munuswamy
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pazhanivel Mohan
- Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Li TY, Zhang ZB. Congenital bronchobiliary fistula: A case report and review of the literature. World J Clin Cases 2019; 7:881-890. [PMID: 31024960 PMCID: PMC6473126 DOI: 10.12998/wjcc.v7.i7.881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital bronchobiliary fistula is a rare developmental abnormality with an abnormal fistula between the respiratory system and biliary tract. The aim of this report is to analyze and summarize the clinical features and experience of diagnosing and treating congenital bronchobiliary fistula (CBBF) occurring in the neonatal period.
CASE SUMMARY The onset of symptoms was 3 d after birth in our patient with progressive cyanosis and respiratory distress, and a large amount of green fluid was noticed in her respiratory secretion. We performed computed tomography (CT), fiberoptic bronchoscopy, and cholangiography to make a diagnosis, as well as fistulography with a bronchoscope for the first time. These examinations provided us with valuable images to make a correct diagnosis. The fistula was dissected and removed with excellent results. Surgical removal of the fistula was successful, and the baby recovered well and was discharged. She has been followed for 4 mo without any signs of discomfort.
CONCLUSION The main symptom of CBBF is bile-like sputum. CT, bronchoscopy, fistulography, and intraoperative cholangiography can provide important evidence for diagnosis. Surgical resection of the fistula is the first choice of treatment.
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Affiliation(s)
- Tian-Yu Li
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Bo Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Shim JR, Han SS, Park HM, Lee EC, Park SJ, Park JW. Two cases of bronchobiliary fistula: Case report. Ann Hepatobiliary Pancreat Surg 2018; 22:169-172. [PMID: 29896580 PMCID: PMC5981149 DOI: 10.14701/ahbps.2018.22.2.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/01/2017] [Accepted: 01/14/2018] [Indexed: 12/30/2022] Open
Abstract
A bronchobiliary fistula, or a biliobronchial fistula (BBF), is a rare condition. It results from an abnormal connection between the biliary and bronchial trees, and is characterized by pathognomonic bilious sputum with suspicious pneumonia. Traditionally, an infectious disease, such as a hydatid infection, has been known to cause a BBF, but BBFs have recently become associated with tumors. In every case, procedures and treatments differ between centers, from simple conservative management to invasive surgical procedures. This case report presents two patients who had BBF after liver resection. Symptoms of each patients were treated and controlled successfully by percutaneous transhepatic biliary drainage tube insertion. We hope that this report helps in the management of BBF in other cases.
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Affiliation(s)
- Jae Ryong Shim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Sung-Sik Han
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Hyung Min Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Eung Chang Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
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Congenital tracheobiliary fistula combined with hypoplastic common hepatic duct: Management by percutaneous transhepatic drainage. Radiol Case Rep 2015; 6:564. [PMID: 27307938 PMCID: PMC4899986 DOI: 10.2484/rcr.v6i4.564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Congenital tracheobiliary or bronchobiliary fistula is a rare developmental anomaly with a persistent communication between the biliary system and the trachea or bronchus. We report a case of a congenital tracheobiliary fistula and hypoplastic common hepatic duct associated with hypoplastic left heart syndrome in a 5-day old boy presenting with bilious endotracheal-tube secretions. The tracheobiliary fistula was treated by surgical resection. Subsequent cholangiography demonstrated dilated intrahepatic bile ducts and a residual fistulous tract with cystic proximal stump that were successfully decompressed by transhepatic drainage catheters before corrective biliary surgery.
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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: 95] [Impact Index Per Article: 7.3] [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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Congenital tracheobiliary fistula: a case report with review of literature. Pediatr Surg Int 2011; 27:899-905. [PMID: 21516501 DOI: 10.1007/s00383-011-2879-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 01/16/2023]
Abstract
Congenital tracheo-or-bronchobiliary fistula is a rare anomaly. Here, we present a malnourished child with persistent and recurrent respiratory symptoms. Flexible bronchoscopy and imaging studies were carried out to ascertain the diagnosis, anatomy and associated anomalies prior to surgery. Patient underwent successful corrective surgery with complete resolution of symptoms.
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Tan Q, Zheng B, Wang J. [A case report of congenital bronchobiliary fistula in adults]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:87-8. [PMID: 20672712 PMCID: PMC6000675 DOI: 10.3779/j.issn.1009-3419.2010.01.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Qingwei Tan
- Department of Thoracic Cardiovascular Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China.
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Annovazzi A, Viceconte G, Romano L, Sciuto R, Maini CL. Detection of a suspected bronchobiliary fistula by hepatobiliary scintigraphy. Ann Nucl Med 2008; 22:641-3. [PMID: 18756368 DOI: 10.1007/s12149-008-0154-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/29/2008] [Indexed: 02/06/2023]
Abstract
Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.
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Affiliation(s)
- Alessio Annovazzi
- Nuclear Medicine Division, Regina Elena Cancer Institute, Via E. Chianesi, 53 00162 Rome, Italy.
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Abstract
Congenital bronchobiliary fistula (CBBF) is quite a rare malformation and the diagnosis is usually made within a few hours or years from birth because of lower respiratory diseases beginning from early infancy. Surgical repair is necessary. Of the 29 cases reported, 4 occurred in adults aged 22-32 years. We detected CBBF incidentally in a 65-year-old woman. During bronchoscopy and thoracic computed tomographic study of the pulmonary nodules, we found an accessory bronchus descending from the carina and composed of a dark green secretion that contained 10% bilirubin. Drip infusion cholangiography revealed air in the left bile duct. Cholescintigraphy showed dilatation of the left bile duct and radiotracer pooling at the top edge of the left hepatic lobe. These findings indicated a narrow fistula between the airway and biliary duct. We attributed the patient's long survival without major complications to the narrowness of the communication. To our best knowledge, this is the fifth and oldest reported adult diagnosed with CBBF.
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Affiliation(s)
- Hideshi Uramoto
- Kumamoto Saishunso National Hospital, National Hospital Organization, Kosi
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Bringas Bollada M, Cabezas Martín MH, Martínez Sagasti F, Ortuño Andériz F. Fístula broncobiliar congénita diagnosticada en la edad adulta. Med Intensiva 2006; 30:475-6. [PMID: 17194407 DOI: 10.1016/s0210-5691(06)74573-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bird R, Fagen K, Taysom D, Silverman ED. A Case of Bronchobiliary Fistula in the Setting of Adult Polycystic Kidney and Liver Disease, with a Review of the Literature. Clin Nucl Med 2005; 30:326-8. [PMID: 15827402 DOI: 10.1097/01.rlu.0000159674.33299.eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of bronchobiliary fistula (BBF) was demonstrated in the setting of polycystic kidney and liver disease (PCKLD) by hepatobiliary scintigraphy. High-resolution noncontrast computed tomography through the liver showed a polycystic liver. A calcified cyst adjacent to the dome of the liver appeared to have a fistulous connection with the lung on coronal reconstructions. Hepatobiliary scan confirmed the fistulous connection. In a review of the literature, BBF has been associated with hydatid cyst disease, trauma, postsurgical states, and malignancy. As demonstrated by this case, BBF is difficult to diagnose and requires a high clinical index of suspicion. Hepatobiliary scintigraphy is the imaging modality of choice to confirm BBF, and PCKLD should be added to the list of antecedent etiologies.
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Affiliation(s)
- Robin Bird
- Department of Radiology, Nuclear Medicine Division, Naval Medical Center San Diego, San Diego, CA 92134-1204, USA
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DiFiore JW, Alexander F. Congenital bronchobiliary fistula in association with right-sided congenital diaphragmatic hernia. J Pediatr Surg 2002; 37:1208-9. [PMID: 12149705 DOI: 10.1053/jpsu.2002.34477] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A case of congenital bronchobiliary fistula is reported in conjunction with another congenital anomaly, right-sided congenital diaphragmatic hernia. The liver was herniated through the diaphragmatic defect into the right chest where a fistula tract was identified from the surface of the liver to the right mainstem bronchus. The patient was treated successfully.
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Affiliation(s)
- John W DiFiore
- Department of Pediatric Surgery, The Children's Hospital at Cleveland Clinic, Cleveland, OH 44195, USA
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RODRIGUES OLAVORIBEIRO, QUIM ANDREACRISTINADEOLIVEIRA, MINAMOTO HÉLIO, MATHEUS ROBERTOSTORTE, SCHMIDT JUNIOR AURELINOFERNANDES. FÍSTULA BÍLIO-BRÔNQUICA: RELATO DE CASO E REVISÃO DE LITERATURA. Acta Cir Bras 1998. [DOI: 10.1590/s0102-86501998000400012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
No presente trabalho é relatado um caso de paciente portadora de fístula bílio-brônquica (FBB) secundária a coledocolitíase tratada no Hospital da Universidade de Mogi das Cruzes e é feita uma revisão da literatura pertinente ao assunto. Tratava-se de uma paciente, 35 anos, feminino, parda, cujo quadro clínico inicial era dor em hipocôndrio direito, de caráter contínuo, acompanhada de icterícia do tipo obstrutivo e bilioptise que atingia até um litro em 24 horas. O diagnóstico foi confirmado por radiografia simples de abdome e ultra-sonografia abdominal. O tratamento consistiu em laparotomia, colecistectomia, coledocotomia com retirada de dois cálculos, drenagem de vias biliares, colangiografia intra-operatória e liberação da cápsula hepática da cúpula frênica direita. A evolução pós-operatória foi satisfatória, com regressão da bilioptise no pós-operatório imediato. Houve regressão progressiva da icterícia em torno do sétimo dia do pós-operatório. A paciente foi estudada com broncografia após 24 meses que mostrou não haver alterações anatômicas dos brônquios basilares direitos pela inundação biliar. A paciente encontra-se no sétimo ano de seguimento sem evidência da doença.
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Eck BD, Passinault WJ. Bronchobiliary fistula. A rare complication of chronic pancreatitis. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1996; 20:213-6. [PMID: 9013283 DOI: 10.1007/bf02803771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONCLUSIONS Bronchobiliary fistula is an in frequent manifestation of common bile duct obstruction. The slowly progressive narrowing of the common duct by the fibrosis of chronic pancreatitis is an even more rare mechanism of such fistula formation with only two cases having been reported previously. A third case of bronchobiliary fistula caused by chronic pancreatitis is presented and its successful management is discussed. BACKGROUND A 54-yr-old male with known chronic pancreatitis presented with a cough productive of copious amounts of bile and with pulmonary infiltrates. METHODS Diagnosis of bronchobiliary fistula was made based on HIDA scan and confirmed by operative cholangiogram. RESULTS Successful correction of this fistula was accomplished by operative closure of the fistulous tract and diversion of the narrowed bile duct by hepaticojejunal bypass.
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Affiliation(s)
- B D Eck
- Department of Surgery, Saint Mary's Hospital, Grand Rapids, MI 49503, USA
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