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Zhang FL, Xu J, Jiang YH, Zhu YD, Wu QN, Shi Y, Zhu FY, Chen JW, Wu LX. Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report. World J Clin Cases 2024; 12:2911-2916. [PMID: 38899298 PMCID: PMC11185352 DOI: 10.12998/wjcc.v12.i16.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/02/2024] [Accepted: 04/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). The complications of TACE include biliary tract infection, liver dysfunction, tumor lysis syndrome, biloma, partial intestinal obstruction, cerebral lipiodol embolism, etc. There are few reports about tracheal fistula induced by TACE. CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC. Laboratory test results showed abnormalities of albumin, hemoglobin, prothrombin time, C-reactive protein, D-dimer, and prothrombin. Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens. Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver. Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal. Drainage for liver abscess by needle puncture under ultrasonic guidance was performed. After 1 month of drainage and anti-infection therapy, the abscess in the liver and the infection in the lung were reduced obviously, and the symptom of expectoration was relieved. CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC. Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.
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Affiliation(s)
- Fu-Long Zhang
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Jing Xu
- Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Yu-Hong Jiang
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Yuan-Dong Zhu
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Qian-Neng Wu
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Yan Shi
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Fang-Yuan Zhu
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Jing-Wen Chen
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Liang-Xiao Wu
- Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
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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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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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4
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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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5
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Achalla LSV, Shinde RK, Jogdand SD, Anand A, Vodithala S. Biliary Stent Obstruction Leading to Bronchobiliary Fistula: A Rare Case Report. Cureus 2022; 14:e26514. [PMID: 35923487 PMCID: PMC9342902 DOI: 10.7759/cureus.26514] [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] [Accepted: 07/02/2022] [Indexed: 11/25/2022] Open
Abstract
Bronchobiliary fistula (BBF) is a rare complication encountered by surgeons, most commonly during the follow-up of surgically managed patients with inflammatory, traumatic, or neoplastic pathologies involving the hepatobiliary tree. We present an operated case of liver hydatidosis with biliary stent obstruction with complaints of bitter green colored sputum and upper abdominal pain. The patient underwent an ERCP-guided stent extraction with reinsertion of a common bile duct stent with complete removal after six weeks. Post operatively, the patient is doing well on follow-up. This complication could be prevented by regular follow-up and timely removal of the placed stents, as a prolonged stay of stent insitu could lead to blockage, leading to complications such as bronchobiliary fistula. Thus, it is concluded that judicious follow-up plays a pivotal role, and timely removal of the stents could prevent such avoidable delayed complications.
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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 2020; 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] [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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Kim HB, Na YS, Lee HJ, Park SG. Bronchobiliary fistula after ramucirumab treatment for advanced gastric cancer: A case report. World J Clin Cases 2019; 7:3039-3046. [PMID: 31624752 PMCID: PMC6795721 DOI: 10.12998/wjcc.v7.i19.3039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bronchobiliary fistula (BBF) is a rare disease characterized by an abnormal connection between the biliary system and bronchi. Traditional causes of BBF include trauma and infections, and more recent causes include malignancies and certain cancer treatments. Ramucirumab is an antivascular endothelial growth factor receptor 2 monoclonal antibody, currently used as a second-line treatment for gastric cancer.
CASE SUMMARY A 43-year-old man visited our hospital with the complaint of jaundice. He was diagnosed with inoperable advanced gastric cancer owing to invasion of the hepatic hilum by the tumor. After percutaneous transhepatic biliary drainage (PTBD) and stent placement, capecitabine and oxaliplatin were administered as first-line palliative chemotherapy. The tumor progressed, and paclitaxel and ramucirumab were administered as second-line chemotherapy. However, on the first day of the second cycle, the patient suddenly developed dyspnea and pneumonia. BBF was diagnosed on the basis of the presence of bilious sputum and the results of computed tomography, and PTBD was repeated.
CONCLUSION This is the first report of BBF after administration of the new antiangiogenic agent ramucirumab.
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Affiliation(s)
- Hong-Beum Kim
- Department of Premedical Course, Chosun University School of Medicine, Dong-gu, Gwangju 501-717, South Korea
| | - Yong Sub Na
- Department of Internal Medicine, Pulomonology, Chosun University Hospital, Dong-gu, Gwangju 501-717, South Korea
| | - Hee-Jeong Lee
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Dong-gu, Gwangju 501-717, South Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Dong-gu, Gwangju 501-717, South Korea
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Chang YC, Lin YM. Bronchobiliary fistula after radiofrequency ablation for hepatocellular carcinoma successfully treated by double drainage. Respirol Case Rep 2018; 6:e00376. [PMID: 30386621 PMCID: PMC6202075 DOI: 10.1002/rcr2.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/17/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022] Open
Abstract
For hepatocellular carcinomas, radiofrequency ablation is extensively used to alleviate primary and metastatic hepatic tumours. Common complications of this procedure include bleeding, infection, and hollow organ perforation. We present the case of a patient with hepatoma who underwent radiofrequency ablation. He had intractable cough with yellowish sputum, particularly while lying down, three weeks after treatment. Chest computed tomography demonstrated a right middle lobe consolidation with pleural effusion and right subphrenic fluid collection. Thoracoscopic decortication was performed under the diagnosis of empyema. The attending anaesthesiologist noted bile-like fluid aspirated from the endotracheal tube. Therefore, we suspected bronchobiliary fistula. Percutaneous transhepatic drainage of the subphrenic fluid and simultaneous cholangiography confirmed bronchobiliary fistula. The patient was successfully treated using percutaneous drainage combined with endoscopic retrograde biliary drainage. An imaging finding of subphrenic fluid collection with right lower lung consolidation after radiofrequency ablation for hepatic tumours should raise the suspicion of bronchobiliary fistula.
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Affiliation(s)
- Yi Chen Chang
- Department of SurgeryShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Yu Min Lin
- Department of HepatogastroenterologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
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9
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Xi XJ, Zhang Y, Yin YH, Li H, Ma DD, Qu YQ. Bronchobiliary fistula following radiofrequency ablation for liver metastases from breast cancer: A case report and literature review. Medicine (Baltimore) 2018; 97:e12760. [PMID: 30412067 PMCID: PMC6221629 DOI: 10.1097/md.0000000000012760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Bronchobiliary fistula (BBF) is a rare clinical condition which is characterized by a channel between biliary tract and bronchial tree. BBF can present with fever, dyspnea, and cough. However, it can be easily misdiagnosed as biliary vomiting, dyspnea, or even severe pneumonia. PATIENT CONCERNS A 53-year-old woman was diagnosed with breast cancer in April 2011 and underwent radical mastectomy and lymph node dissection, chemotherapy, and radiotherapy. Unfortunately, the patient suffered from bone metastasis during the 1st year and liver metastasis during the 2nd year after radical mastectomy. In 2013, the patient underwent transcatheter arterial chemoembolization therapy twice for liver metastasis. The patient was then treated with radiofrequency ablation (RFA) in 2016. Unfortunately, the patient developed a cough with bitter-tasting yellow sputum and chest tightness 2 weeks after the RFA treatment. Approximately 6 months later, the patient still complained of a cough with yellow sputum and persistent chest tightness. The patient was then admitted to our department. DIAGNOSES The presence of bile in the sputum supported a diagnosis of BBF. Bronchoscopy was performed, and the presence of bile in the lavage fluid confirmed the diagnosis of BBF. INTERVENTIONS The patient was treated with antibiotics including sulbactam, cefoperazone, levofloxacin and meropenem, was well as hepatoprotectants, nutritional support and other supportive treatments in our department. OUTCOMES The patient died because of liver failure. LESSONS This case demonstrates that we should consider the possibility of BBF when patients experience a recurrent cough with discolored sputum after RFA. In particular, a diagnosis of BBF should be considered in patients who do not respond to antibiotic treatment.
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Pinsker N, Papoulas M, Sodergren M, Harrison P, Heaton N, Menon K. Successful endoscopic management of a persistent bronchobiliary fistula with Histoacryl ®/Lipiodol ® mixture. Ann R Coll Surg Engl 2018; 100:e73-e77. [PMID: 29543060 PMCID: PMC5958863 DOI: 10.1308/rcsann.2018.0026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction A bronchobiliary fistula (BBF) following liver directed therapy (resection/ablation) is a rare complication in which an abnormal communication between the biliary tract and bronchial tree is formed. This case report describes the successful management of a persistent BBF following multiple liver wedge resections and microwave ablation in a patient with a metastatic neuroendocrine tumour of the terminal ileum. Case history A 69-year-old man presented with unexplained weight loss and was subsequently diagnosed with a neuroendocrine tumour of the terminal ileum and liver metastasis. Following elective right hemicolectomy and multiple bilobar liver wedge resections combined with liver microwave ablation, he developed an early bile leak. A month later, a right subphrenic collection was identified and four months following surgery, biloptysis was noted. Numerous attempts with endoscopic retrograde biliary drainage (ERBD) failed to achieve sufficient drainage. The patient was treated successfully with endoscopic injection of a mixture of Histoacryl® glue (B Braun, Sheffield, UK) and Lipiodol® (Guerbet, Solihull, UK). There was no evidence of the BBF one year following intervention. Conclusions This novel approach for persistent BBF management using endoscopic Histoacryl® glue embolisation of the fistula tract should be considered either as an adjunct to ERBD or when biliary tract decompression by drainage and/or sphincterotomy fails, prior to proceeding with surgical interventions.
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Affiliation(s)
- N Pinsker
- King’s College Hospital NHS Foundation Trust, UK
| | - M Papoulas
- King’s College Hospital NHS Foundation Trust, UK
| | | | - P Harrison
- King’s College Hospital NHS Foundation Trust, UK
| | - N Heaton
- King’s College Hospital NHS Foundation Trust, UK
| | - K Menon
- King’s College Hospital NHS Foundation Trust, UK
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11
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Yang L, Guo Z, Yang L, Ju W, Wang D, He X. Orthotopic liver transplantation in a pediatric patient with iatrogenic Budd-Chiari syndrome complicated by bronchobiliary fistula. Pediatr Transplant 2017; 21. [PMID: 28745424 DOI: 10.1111/petr.13008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
We report a clinical case of OLT in a 10-year-old boy with iatrogenic BCS and BBF following three operations because of traumatic liver rupture and pulmonary contusion caused by a traffic accident 4 years ago. On follow-up, the child was asymptomatic.
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Affiliation(s)
- Lei Yang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu Yang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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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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Zeng Z, Cai M, Huang W, Huang J, Chen X, Shan H, Zhu K. Delayed bronchobiliary fistula following radiofrequency ablation in a patient with hepatocellular carcinoma: A case report and lesson regarding treatment. Oncol Lett 2016; 11:3213-3217. [PMID: 27123093 DOI: 10.3892/ol.2016.4366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/24/2016] [Indexed: 01/13/2023] Open
Abstract
Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA) of hepatocellular carcinoma. The rupture of a biloma following RFA may result in the development of BBF, with their early detection and timely management important in the prevention of BBF. The current study presents a case of BBF, which developed at 17 months after radiofrequency ablation (RFA), due to biloma rupture in a patient with hepatocellular carcinoma. Despite the percutaneous drainage of the biloma following BBF, the persistent fever did not resolve due to biliary infection. Finally, an extensive surgical intervention was performed. The magnetic resonance imaging (MRI) scans that had been performed following RFA were reviewed, and it was found that the biloma and increased bile leakage had presented prior to biloma rupture. For that reason, it is advised that patients who present with biloma following RFA should receive regular follow-up MRI scans. Biloma enlargement could be a predictor for the development of BBF; therefore, timely drainage of an enlarging biloma may be able to prevent this complication.
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Affiliation(s)
- Zhaolin Zeng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Mingyue Cai
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Wensou Huang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Jingjun Huang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiuzhen Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Hong Shan
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Kangshun Zhu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
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