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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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Mardani P, Kamran H, Khosravi F, Shahriarirad R, Shahabinejad P, Geramizadeh B, Soleimani N, Amirian A. Bronchobiliary fistulae as a complication of untreated pulmonary hydatid cyst presenting with bilioptysis: A report of two cases. Clin Case Rep 2023; 11:e7524. [PMID: 37323254 PMCID: PMC10264942 DOI: 10.1002/ccr3.7524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/29/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023] Open
Abstract
We reported two patients, a 45-year-old lady and a 48-year-old man, known cases of untreated liver and lung hydatid cysts complicated with bronchobiliary fistulae. Surgery was performed, and bronchobiliary fistulae were diagnosed intraoperatively. Lobectomy was done on the lobe, which was chronically infected. Symptoms resolved after surgery in both cases. Green-colored sputum in a patient with a history of echinococcosis should raise the physician's attention to the probability of a connection between the bronchial tree and the biliary tract. Surgery in advanced cases is a suitable therapeutic option.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Department of SurgeryShiraz University of Medical SciencesShirazIran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Fateme Khosravi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | - Bita Geramizadeh
- Department of Pathology, School of MedicineShiraz University of Medical SciencesShirazIran
- Shiraz Transplant Research Center (STRC)Shiraz University of Medical SciencesShirazIran
| | - Neda Soleimani
- Shiraz Transplant Research Center (STRC)Shiraz University of Medical SciencesShirazIran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Department of SurgeryShiraz University of Medical SciencesShirazIran
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Hydatid cyst: Introducing a new surgical approach towards hepato-pulmonary fistula, a case report. Int J Surg Case Rep 2022; 93:106898. [PMID: 35306331 PMCID: PMC8933557 DOI: 10.1016/j.ijscr.2022.106898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/23/2022] Open
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Seyed-Alagheband SA, Shahmoradi MK, Shekouhi R. Posttraumatic bronchobiliary fistulae due to foreign body remnants after a road traffic injury: a case report. J Med Case Rep 2021; 15:291. [PMID: 34020706 PMCID: PMC8139863 DOI: 10.1186/s13256-021-02859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Bronchobiliary fistula is an extremely rare disease that involves abnormal communication between a hepatic segment and bronchial tree. It is mostly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Case presentation We experienced an extremely rare case of bronchobiliary fistula after motor vehicle accident. A 15-year-old Persian boy visited our clinic with chief complaints of persistent pleuritic chest pain, productive cough, weight loss, and fever for 2 months. Coronavirus disease 2019 reverse transcription polymerase chain reaction test was negative. Chest X-ray revealed hazy opacification of right lower lobe. Bronchoalveolar lavage for acid-fast bacillus came back negative. Thoracoabdominal computed tomography scan revealed a collection in segment VIII of the liver communicating with another 13 × 5 cm multiloculated collection in the lower lobe of the right lung, with air foci within the collection. Right posterolateral thoracotomy was performed with the impression of bronchobiliary fistula. Drainage of hepatic collection with debridement, diaphragmatic repair, and open decortication of lung followed by resection of the involved segment of the right lung was performed. Histopathologic evaluations revealed abscess formation in pulmonary tissue, and many multinucleated giant cells were seen that appear to be due to foreign body remnants after previous laparotomy surgery. The foreign body seemed to be the remnants of Surgicel absorbable hemostat. Conclusions Herein, we report an extremely rare case of a posttraumatic bronchobiliary fistula caused by remnants of Surgicel hemostatic agent. Bronchobiliary fistula is mainly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Migration and erosion of oxidized regenerated cellulose through the diaphragm seems to be the causative factor of bronchobiliary fistula in this patient.
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Affiliation(s)
| | | | - Ramin Shekouhi
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran.
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Percutaneous Treatment of Bronchobiliary Fistula: Report of a Successful Transhepatic Embolization and a Decision-Making Strategy Driven by Systematic Literature Review. Cardiovasc Intervent Radiol 2021; 44:1005-1016. [PMID: 33928407 DOI: 10.1007/s00270-021-02837-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
Bronchobiliary fistula is a rare condition characterized by bile leaking into the bronchial tree causing biliptysis. It may arise from liver infection or as a consequence of resection and thermal ablation of cancer. Currently, there is no consensus about the treatment strategy. Surgery is considered the main therapy by most authors. However, this systematic literature review shows that the success rate of percutaneous treatments may reach 75%. Adding to such evidence, we also report the case of a woman affected by iatrogenic bronchobiliary fistula secondary to liver thermal ablation, successfully treated with percutaneous drainage plus embolization. Summarizing these results, we encourage the percutaneous management of bronchobiliary fistula by providing a 3-step decision-making algorithm, aimed at reducing the need for major surgery.
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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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Giri S, Sundaram S, Darak H, Kumar S, Bhatia S. Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center. Clin Endosc 2020; 53:727-734. [PMID: 32819052 PMCID: PMC7719417 DOI: 10.5946/ce.2020.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/24/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited. METHODS We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks. RESULTS In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP. CONCLUSION Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Harish Darak
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sanjay Kumar
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
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He YF, Liang TY, Mo ST, Chen ZJ, Han CY, Ye XP, Peng T. Bile in bronchi: A case report. Respir Med Case Rep 2020; 30:101075. [PMID: 32489847 PMCID: PMC7260606 DOI: 10.1016/j.rmcr.2020.101075] [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: 12/16/2019] [Accepted: 05/03/2020] [Indexed: 12/05/2022] Open
Abstract
Background The biliary bronchial fistula is rare and difficult to treat. Here we report a 49-year-old woman diagnosed with biliary bronchial fistula due to cough with yellow-green sputum. Case presentation this is a typical case of the biliary bronchial fistula with typical symptoms. The position of the abscess cavity below the diaphragm could not be catheter drainage. After anti-infection treatment, yellow-green sputum was reduced. Follow-up showed a good prognosis. Conclusion biliary bronchial fistula is rare in the clinic, combined with chest and abdomen infection.
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Affiliation(s)
- Yong-Fei He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Tian-Yi Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Shu-Tian Mo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Zi-Jun Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Chuang-Ye Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xin-Ping Ye
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Tao Peng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
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9
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[Biliopleural fistula after laparoscopic cholecystectomy in a nonagenarian patient]. Rev Esp Geriatr Gerontol 2019; 54:364-365. [PMID: 30777386 DOI: 10.1016/j.regg.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/09/2018] [Accepted: 01/03/2019] [Indexed: 11/21/2022]
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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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Percutaneous Transhepatic Embolization of a Bronchobiliary Fistula Developing Secondary to a Biloma After Conventional Transarterial Chemoembolization in a Patient with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 39:628-31. [PMID: 26510660 DOI: 10.1007/s00270-015-1224-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/14/2015] [Indexed: 12/17/2022]
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