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Chen YX, Deng ZH, Zhao H, Zhou BY, Guo JJ, Zeng G, Qian JX. Bronchobiliary fistula in a patient with liver cancer. Hepatobiliary Pancreat Dis Int 2024; 23:523-525. [PMID: 36732113 DOI: 10.1016/j.hbpd.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Yao-Xin Chen
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Zhi-Hua Deng
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Hao Zhao
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Bi-Ying Zhou
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Jing-Jing Guo
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Gang Zeng
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China
| | - Jin-Xian Qian
- Department of Respiratory and Critical Care Medicine, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou 215000, China.
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2
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Yang Y, Chen Q, Hu Y, Zhao L, Cai P, Guo S. Cholecystopleural fistula: A case report and literature review. Medicine (Baltimore) 2024; 103:e39366. [PMID: 39151511 PMCID: PMC11332735 DOI: 10.1097/md.0000000000039366] [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: 05/27/2024] [Revised: 07/20/2024] [Accepted: 07/30/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Gallstone with acute cholecystitis is one of the most common diseases in the clinic. If the disease is serious, gallbladder gangrene, perforation, and sepsis may be caused. Gallbladder diseases rarely cause thoracic-related complications, especially pleural fistula, which is very rare in clinical practice. PATIENT CONCERNS A 52-year-old male patient was admitted to the emergency department for 1 month with recurrent right middle and upper abdominal pain. DIAGNOSIS Computed tomography diagnosis: cholecystitis and peri-inflammation, small abscess around the base of the gallbladder, local peritonitis, and bilateral pleural effusion. INTERVENTIONS After admission, conservative treatment was given. On the 4th day of admission, the symptoms worsened, and an emergency catheter drainage was performed on the right thoracic cavity to extract 900 mL of dark yellow effusion. After the operation, a large amount of bili-like fluid was continuously drained from the thoracic drainage tube. After the iatrogenic biliary fistula caused by thoracic puncture was excluded, cholecystopleural fistula was considered to be cholecystopleural fistula. On the 6th day of admission, endoscopic retrograde cholangiopancreatography (ERCP) + cholecystography + Oddi sphincterotomy + laminating biliary stent was performed in the emergency department, and cholecystopleural fistula was confirmed during the operation. OUTCOMES The patient recovered well after surgery, computed tomography examination on the 20th day after surgery indicated that pleural effusion was significantly reduced, and the patient was cured and discharged. The patient returned to the hospital 8 months after the ERCP operation to pull out the bile duct-covered stent. The patient did not complain of any discomfort after the postoperative follow-up for 3 years, and no recurrence of stones, empyema, and other conditions was found. CONCLUSION Cholecystopleural fistula is one of the serious complications of acute cholecystitis, which is easy to misdiagnose clinically. If the gallbladder inflammation is severe, accompanied by pleural effusion, the pleural effusion is bili-like liquid, or the content of bilirubin is abnormally elevated, the existence of the disease should be considered. Once the diagnosis is clear, active surgical intervention is needed to reduce the occurrence of complications. Endoscopic therapy (ERCP) can be used as both a diagnostic method and an important minimally invasive treatment.
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Affiliation(s)
- Yong Yang
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
| | - Qian Chen
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
| | - Yi Hu
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
| | - Liangsong Zhao
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
| | - Pengcheng Cai
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
| | - Suqi Guo
- Department of General Surgery, The First People’s Hospital of Shuangliu District, Chengdu/West China Airport Hospital of Sichuan University, China
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3
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Zhao B, Huang RC, Xia Y, Dong Y, Huang H, Zhao L, Zhang W. Selective bronchial occlusion for acquired bronchobiliary fistula caused by treatment of hepatocellular carcinoma: A case series. Respirol Case Rep 2024; 12:e01440. [PMID: 39086725 PMCID: PMC11289238 DOI: 10.1002/rcr2.1440] [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: 05/23/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
Acquired bronchobiliary fistula (ABBF) is very rare among the complications that occur in patients with hepatocellular carcinoma (HCC) after treatment. Although surgery and drainage have been the main methods for treating ABBF for a long time, they are not entirely suitable for patients with refractory ABBF resulting from HCC therapy. In this study, we present four cases of ABBF caused by HCC treatment, who were treated using selective bronchial occlusion (SBO). Among the 4 patients with ABBF treated with SBO, 3 cases successfully blocked ABBF with SBO, and the treatment success rate was 75%. All successfully treated patients reported disappearance of symptoms of bilioptysis and cough was alleviated. No life-threatening adverse reactions were reported following SBO intervention, and no deaths occurred. We believe that the use of video bronchoscopy to place a self-made silicone plug in the bronchus to treat refractory ABBF is a feasible palliative treatment, which can significantly improve the condition of ABBF patients.
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Affiliation(s)
- Bi Zhao
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
| | - Rui Chen Huang
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
| | - Yang Xia
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
- Center of Critical Care Medicinethe First Affiliated Hopital of Second Military Medical UniversityShanghaiChina
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
| | - Lijun Zhao
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicinethe First Affiliated Hospital of Second Military Medical UniversityShanghaiChina
- Center of Critical Care Medicinethe First Affiliated Hopital of Second Military Medical UniversityShanghaiChina
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4
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Freidkin L, Azem K, Pertzov B, Izhakian S, Rosengarten D, Kramer MR. Endobronchial closure of broncho-biliary fistula using Amplatzer device: Case report. Respir Med Case Rep 2023; 46:101943. [PMID: 38025252 PMCID: PMC10661852 DOI: 10.1016/j.rmcr.2023.101943] [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: 07/18/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Broncho-biliary fistula (BBF) is an extremely rare but serious medical condition resulting from pathological communication between the biliary system and the bronchial tree. Treatment options include both surgical and non-surgical approaches. Several endobronchial techniques, such as the spigot and glue, can be used for this purpose. This report discusses a patient who developed a broncho-biliary fistula following a liver biopsy. The BBF was diagnosed during bronchoscopy and successfully treated with an endobronchial Amplatzer device. To the best of our knowledge, this is the first report of the use of the Amplatzer device to manage BBF.
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Affiliation(s)
- Lev Freidkin
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Anesthesiology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Izhakian
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R. Kramer
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Trieu M, Weihe EK, Sunwoo BY. Bilioptysis Caused by Bronchobiliary Fistula. Am J Respir Crit Care Med 2023; 208:896-897. [PMID: 37339503 DOI: 10.1164/rccm.202303-0370im] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023] Open
Affiliation(s)
- Megan Trieu
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, Department of Medicine, and
| | - Elizabeth K Weihe
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Bernie Y Sunwoo
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, Department of Medicine, and
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6
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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: 2.0] [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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Didden P, Bruijnen RCG, Vonken EJPA, Vleggaar FP. Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl. Endoscopy 2023; 55:484-485. [PMID: 37105159 PMCID: PMC10139763 DOI: 10.1055/a-2017-9651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Paul Didden
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
| | - Rutger C G Bruijnen
- University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands
| | - Evert-Jan P A Vonken
- University Medical Center Utrecht, Department of Radiology, Utrecht, Netherlands
| | - Frank P Vleggaar
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
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8
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Nishioki T, Koyama R, Okubo H, Fukuo Y, Takasaki Y, Yae T, Banno T, Kido K, Takahashi K, Shiina S, Ikejima K. Endobronchial Watanabe Spigot Placement for Hepatic Abscess and Bronchobiliary Fistula Following Radiofrequency Ablation for Hepatocellular Carcinoma. Intern Med 2023; 62:999-1004. [PMID: 35945018 PMCID: PMC10125827 DOI: 10.2169/internalmedicine.0392-22] [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] [Indexed: 11/06/2022] Open
Abstract
A bronchobiliary fistula (BBF) is an uncommon but severe complication after radiofrequency ablation (RFA). However, the definitive salvage methods are controversial. We herein report a patient with hepatocellular carcinoma with hepatic abscess and BBF following RFA. We also review previous reports of BBF after RFA. The patient was a man in his 70s who underwent RFA for recurrent hepatocellular carcinoma in the subphrenic area. Despite percutaneous transhepatic abscess drainage, bilioptysis persisted. Finally, the BBF was occluded with an endobronchial Watanabe spigot under fiber-optic bronchoscopy. Placing an endobronchial Watanabe spigot should be considered as a salvage therapy for refractory BBF following RFA.
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Affiliation(s)
- Toshihiko Nishioki
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, Japan
| | - Ryo Koyama
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, Japan
| | - Hironao Okubo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | - Yuka Fukuo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | - Toshifumi Yae
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, Japan
| | - Takamitsu Banno
- Department of Thoracic Surgery, Juntendo University Nerima Hospital, Japan
| | - Kenji Kido
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University School of Medicine, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kenichi Ikejima
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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9
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Li B, Li XG. Percutaneous microwave ablation‑induced hepatic artery‑pulmonary artery fistula: A rare case report. Mol Clin Oncol 2023; 18:20. [PMID: 36798469 PMCID: PMC9926041 DOI: 10.3892/mco.2023.2616] [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: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Microwave ablation (MWA) is safe and effective for patients with unresectable primary and secondary hepatic tumors, but it also has a series of complications. The present study reported on the case of a 60-year-old male patient with progression of solitary liver metastasis who underwent multiple courses and lines of chemotherapy. Hepatic artery-pulmonary artery fistula due to thermal damage may occur after MWA for hepatic tumor adjacent to the diaphragm. Symptomatic improvement was achieved by trans-arterial embolization and hepatic arteriography indicated complete occlusion of the fistula. The postoperative course was uneventful and the patient was discharged three days later. This rare complication should be taken into consideration in clinical treatment.
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Affiliation(s)
- Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China,Correspondence to: Dr Xiao-Guang Li, Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 1 Dahua Street, Dongcheng, Beijing 100730, P.R. China
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10
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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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Didden P, Bruijnen RCG, Vonken EJPA, Vleggaar FP. Endoscopic embolization of a refractory bronchobiliary fistula by endoscopic retrograde cholangiography using coils and Histoacryl. Endoscopy 2022; 55:E268-E269. [PMID: 36427496 PMCID: PMC9831773 DOI: 10.1055/a-1974-9202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paul Didden
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
| | | | | | - Frank P. Vleggaar
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
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12
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Lo YC, Hsu PW, Chew FY, Chen HY. Special presentation of bronchobiliary fistula after transcatheter arterial chemoembolization: A case report. Medicine (Baltimore) 2022; 101:e31596. [PMID: 36401479 PMCID: PMC9678547 DOI: 10.1097/md.0000000000031596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Transcatheter arterial chemoembolization (TACE) is a widely adopted treatment for advanced stage hepatocellular carcinoma (HCC). Nevertheless, several complications may occur, such as hepatic artery injury, nontarget embolization, pulmonary embolism, hepatic abscess, biloma, biliary strictures, and hepatic failure. However, bronchobiliary fistula is rarely mentioned before. PATIENT CONCERNS A 65-year-old man with HCC underwent the TACE procedure, and then he encountered fever, dyspnea, abdominal pain, and abundant yellowish purulent bronchorrhea. DIAGNOSIS Bronchobiliary fistula was diagnosed based on the computed tomography (CT) scan of his chest, which revealed the right lower lobe of his lung was connected to a hepatic cystic lesion. INTERVENTIONS Percutaneous transhepatic cystic drainage was performed, and we obtained yellowish bile, showing the same characteristics as the patient's bronchorrhea. OUTCOMES We kept drainage of his biloma and provided supportive care as the patient wished. Unfortunately, the patient passed away due to progressive right lower lobe pneumonia 2 weeks later. LESSONS This case exhibits a typical CT scan image that was helpful for the diagnosis of post-TACE bronchobiliary fistula. Post-TACE bronchobiliary fistula formation hypothesis includes biliary tree injuries with subsequent biloma formation and diaphragmatic injuries. Moreover, the treatment of bronchobiliary fistula should be prompt to cease pneumonia progression. Therefore, we introduce this rare complication of post-TACE bronchobiliary fistula in hopes that future clinicians will keep earlier intervention in mind.
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Affiliation(s)
- Yuan-Chun Lo
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ping-Wen Hsu
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Fatt-Yang Chew
- Department of Medical Imaging, China Medical University Hospital, Taiwan
| | - Hung-Yao Chen
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * Correspondence: Hung-Yao Chen, Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan, No. 2, Yude Road, North District, Taichung City 40447, Taiwan (e-mail: )
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13
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Abdurabuh E, Khairo M, Bakhsh A, Alsharif M, AlYamani W. Use heat with caution! Pleurobiliary fistula after hepatocellular carcinoma microwave ablation in lymphoma patient: A case study. Radiol Case Rep 2022; 17:3871-3876. [PMID: 35982719 PMCID: PMC9379976 DOI: 10.1016/j.radcr.2022.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Thermal ablation by microwave ablation (MWA) or radiofrequency ablation (RFA) is a frequently used technique for hepatic lesion treatment due to its low rate of complications. Surgery, transarterial chemoembolization (TACE), and yttrium-90 (Y-90) transarterial radioembolization (TARE) are other ways to treat hepatic lesions. Thoracobiliary fistula (TBF) is a rare side effect of thermal ablation. Other side effects include vascular injury, damage to the biliary system, and infection. We present the case of a 62-year-old male patient who has a history of lymphoma and was diagnosed with a hepaticellular carcinoma lesion on follow-up CT in segment VII, which appeared in close relation to the right diaphragm. The patient had been through several interventional procedures, including Y-90 therapy, TACE, and MWA with thermal impact, which resulted in a biloma forming and ramping up the progression of pleurobiliary fistula, which is confirmed by HIDA scan, this case highlights the significance of monitoring patients after thermal ablation, particularly in cases of large justa-diaphragmatic tumors, to detect any diaphragmatic or biliary tree injuries.
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Affiliation(s)
- Etedal Abdurabuh
- Department of Radiology, Al Noor Specialist Hospital, Makkah, Saudi Arabia
- Corresponding author.
| | - Mutaz Khairo
- Department of Radiology, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - Aquib Bakhsh
- Department of Radiology, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - May Alsharif
- Department of Radiology, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - Wael AlYamani
- Department of Radiology, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
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Ngo J, Wenger M, Chee A. Bilioptysis associated with alcohol hepatitis without evidence of bronchobiliary fistula: A rare case report. Respirol Case Rep 2022; 10:e01028. [PMID: 36051363 PMCID: PMC9424842 DOI: 10.1002/rcr2.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022] Open
Abstract
The presence of bilirubin in the sputum is uncommon but, when present, is most commonly associated with the presence of bronchobiliary fistula, which could be associated with a number of underlying conditions. However, the finding of bilioptysis without bronchobiliary fistula is uncommon, with one associated mechanism postulated to involve increased capillary membrane permeability. This case report describes a patient presenting with bilioptysis while being medically managed with prednisolone for severe alcoholic hepatitis. The patient developed hospital‐acquired pneumonia during her hospitalization associated with bilioptysis, resulting in progressive respiratory failure requiring ventilatory support. Alcohol‐related pulmonary dysfunction alters pulmonary immune processes, leading to increased susceptibility to pulmonary infection and disrupting the basal alveolar epithelial membrane, thus increasing permeability. This patient's findings were in the absence of a bronchobiliary or bronchopleural fistula, and we hypothesize that increased capillary membrane permeability was contributory to the bilioptysis in this case.
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Affiliation(s)
- Jennifer Ngo
- Department of Medicine University of Calgary Calgary Canada
- South Health Campus Hospital Calgary Canada
| | | | - Alex Chee
- Department of Medicine University of Calgary Calgary Canada
- South Health Campus Hospital Calgary Canada
- Foothills Medical Centre Calgary Canada
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A C, M D, Ka S. Multimodal Approach to Acquired Bronchobiliary Fistula Secondary to Hepaticojejunostomy Stricture Following Yttruim-90 Therapy. Am Surg 2022:31348221088964. [PMID: 35451877 DOI: 10.1177/00031348221088964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bronchobiliary fistula (BBF) is an abnormal connection between the bronchial system and the biliary tree. It pathognomonically presents with bilioptysis (production of bilious-tinged sputum) and is associated with mortality rates up to 12.7%. Here we present a 56-year-old male with stage IV neuroendocrine pancreatic cancer status post pylorus-preserving pancreaticoduodenectomy. The patient developed an acquired BBF secondary to repeated Yttrium-90 radioembolization therapy that resulted in complete stenosis of the hepaticojejunostomy (HJ) anastomosis. The diagnosis was confirmed using cholescintigraphy and bronchoscopy. Biliary decompression with percutaneous transhepatic cholangiogram was unsuccessful, necessitating resection of the HJ anastomosis with salvage bilioenteric reconstruction using Kasai-type anastomosis between the pancreaticobiliary limb and hepatic duct. Complete resolution was noted following surgery. Although a minimally invasive approach to treatment of BBF may be favorable, patients with previous biliary reconstruction may warrant multimodal treatments including percutaneous procedures and complex surgical reconstructions.
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Affiliation(s)
- Chopra A
- Department of Surgery, RinggoldID:89021University of Toledo, Toledo, OH, USA
| | - DeVries M
- Department of Surgery, RinggoldID:89021University of Toledo, Toledo, OH, USA
| | - Simo Ka
- Department of Surgery, RinggoldID:89021University of Toledo, Toledo, OH, USA.,Department of Surgery, Toledo Hospital, Toledo, OH, USA
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Biliothoracic Fistula after Microwave Ablation of Liver Metastasis : Literature Review. Emerg Med Int 2021; 2021:9913076. [PMID: 34123430 PMCID: PMC8170678 DOI: 10.1155/2021/9913076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Microwave ablation is a safe and effective interventional approach, widely used in the treatment of unresectable primary or metastatic hepatic lesions. Thoracobiliary fistula is a rare postablation complication that can be treated with a conservative or surgical approach. We reviewed aetiology, pathogenesis, clinical picture, diagnostic possibilities, and therapeutic options for biliothoracic fistula developed after microwave ablation of liver metastasis. Furthermore, we reported our experience of successful conservative management of a nonhealing thoracobiliary fistula occurred after percutaneous thermal ablation of colorectal cancer liver metastasis. Our case supports a conservative approach based on percutaneous biliary system decompression and synthetic glue embolization for the treatment of combined biliopleural and biliobronchial fistula.
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