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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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Gautam V, Kumar V, Agarwal S, Gupta S. Delayed diagnosis of bronchobiliary fistula complicating a pediatric living donor liver transplantation: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:293-298. [PMID: 37885160 PMCID: PMC10772266 DOI: 10.4285/kjt.23.0044] [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: 08/04/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Bronchobiliary fistula (BBF) is a very rare condition in children. Only a few pediatric BBF cases have been reported, in the context of a ruptured hydatid cyst or liver abscess. BBF after living donor liver transplantation (LDLT) has not been reported in the pediatric literature. We report a 7-year-old female child with Wilson disease, who developed BBF post-LDLT. She had a clinically uneventful course in the immediate post-transplant period. She was readmitted on postoperative day (POD) 75 with a productive cough and respiratory difficulty, which was diagnosed as bilioptysis secondary to BBF. Endoscopic retrograde cholangiopancreaticography was attempted but failed. Exploratory laparotomy showed a fistula from the strictured biliary anastomotic site to the right thoracic cavity; it was excised, and a Roux-en-Y hepaticojejunostomy was performed. She tolerated the procedure well and remained clinically well on follow-up through POD 185. BBF is extremely rare in children. This is the first case report of BBF in a child following LDLT. BBF requires a high index of suspicion for a timely intervention to prevent subsequent complications.
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Affiliation(s)
- Vipul Gautam
- Department of Pediatric Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Vikram Kumar
- Department of Pediatric Hepatology, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Shaleen Agarwal
- Department of Liver Transplant Surgery, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
| | - Subhash Gupta
- Department of Liver Transplant Surgery, Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, New Delhi, India
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Bing Z, Chen R, Xing P, Ren Y, Hou K. Congenital Bronchobiliary Fistula: A Case Report and Literature Review. Front Pediatr 2021; 9:686827. [PMID: 34422718 PMCID: PMC8371316 DOI: 10.3389/fped.2021.686827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Congenital bronchobiliary fistula (CBBF) is a rare disease. Children with CBBF mostly have atypical clinical manifestations that can be easily missed. We report a case of a child with CBBF who was diagnosed with fistulography with the help of an endobronchial blocker and a fiberoptic bronchoscope. The CBBF was successfully removed by thoracoscopic surgery.
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Affiliation(s)
- Zhen Bing
- Heart Center, Qingdao Women and Children's Hospital, Qingdao, China
| | - Rui Chen
- Heart Center, Qingdao Women and Children's Hospital, Qingdao, China
| | - Pengchao Xing
- Heart Center, Qingdao Women and Children's Hospital, Qingdao, China
| | - Yueyi Ren
- Heart Center, Qingdao Women and Children's Hospital, Qingdao, China
| | - Kefeng Hou
- Heart Center, Qingdao Women and Children's Hospital, Qingdao, China
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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 DOI: 10.3892/mco.2019.1935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Baleato-González S, Vieira-Leite C, Alvárez-Castro AM, García-Figueiras R. Demonstration of a bronchobiliary fistula using magnetic resonance image with hepatospecific contrast agent. RADIOLOGIA 2017; 59:540-543. [PMID: 28495458 DOI: 10.1016/j.rx.2017.04.002] [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: 09/13/2016] [Revised: 01/03/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
Bronchobiliary fistulas are a rare entity of difficult diagnosis. The utility of magnetic resonance image (MRI) with hepatospecific contrast agents to demonstrate such condition is seldom described in the literature. This case reports a patient with pulmonary infection with a past history of hepatic surgery for hydatid disease in whom the presence of bile in the sputum rose the suspicious of a bronchobiliary fistula. MRI with hepatospecific contrast agents showed the communication between the biliary and bronchial tree and provided anatomic data to allow a therapeutic approach.
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Affiliation(s)
- S Baleato-González
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela (A Coruña), España
| | - C Vieira-Leite
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela (A Coruña), España.
| | - A M Alvárez-Castro
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela (A Coruña), España
| | - R García-Figueiras
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela (A Coruña), España
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Hai S, Iimuro Y, Hirano T, Suzumura K, Yada A, Fujimoto J. Bronchobiliary fistula caused after hepatectomy for hepatocellular carcinoma: a case report. Surg Case Rep 2016; 2:147. [PMID: 27921278 PMCID: PMC5138177 DOI: 10.1186/s40792-016-0273-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/01/2016] [Indexed: 12/15/2022] Open
Abstract
Background A bronchobiliary fistula, an intercommunication between the biliary tract and bronchial trees, is an extremely rare complication after hepatectomy. Case presentation A 70-year-old male underwent partial resection of the liver for recurrent hepatocellular carcinoma under a thoracoabdominal approach. The immediate postoperative clinical course was uneventful, but the patient was febrile and laboratory examinations revealed leukocytosis on the 15th postoperative day. An intraabdominal abscess was suspected based on the computed tomography findings, and percutaneous drainage was performed. Bile was drained, and fluoroscopy using a contrast medium from the drainage tube revealed a communication between the cavity and the common hepatic duct. Two weeks after drainage, bilioptysis was seen. Fistulography demonstrated the presence of the bronchus in the right lower lobe of the lung via the subphrenic space. Therefore, the patient was diagnosed to have a bronchobiliary fistula. Fistulography revealed closure of the communication with the bronchus about a month after drainage. However, the bile leakage and bilioptysis did not stop even after endoscopic nasogastric biliary drainage, and ethanol injection therapy were performed. Eventually, residual right bisectionectomy without resection of the fistulous tract and involved lung was performed to remedy the intractable bile leakage. The clinical course after the reoperation was good without bile leakage, bilioptysis, or pulmonary disorders, and the patient was discharged 40 days after reoperation. Conclusions We experienced a rare case of bronchobiliary fistula that occurred after hepatectomy for hepatocellular carcinoma. Careful attention should be paid to prevent bile leakage during hepatectomy, since bile leakage has the potential to cause a bronchobiliary fistula.
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Affiliation(s)
- Seikan Hai
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Yuji Iimuro
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tadamichi Hirano
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazuhiro Suzumura
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akito Yada
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Kuo YS, Lee SC, Chang H, Hsieh CB, Huang TW. Erratum: Thoracoscopic surgery for bronchobiliary fistula: a case report. J Cardiothorac Surg 2015. [PMID: 26210674 PMCID: PMC4515318 DOI: 10.1186/s13019-015-0280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yen-Shou Kuo
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Shih-Chun Lee
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Hung Chang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Chung-Bao Hsieh
- Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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