Congenital Bronchobiliary Fistula: A Case Report and Literature Review

Late onset of biliobronchial fistula - a serious complication of hemihepatectomy for atrophic liver with hepatolithiasis: a case report and review of the literature

BACKGROUND

Acquired bronchobiliary fistula (BBF) is a rare but life-threatening complication that can occur as a result of oncological processes, inflammatory reactions, parasite infections, thoracoabdominal trauma, or invasive procedures associated with iatrogenic injury. However, the potential etiology of BBF caused by instrumental issues when using ultrasonic scalpels resulting in diathermy burn and its post-burn effects has never been reported.

CASE PRESENTATION

Herein, we present a case of a 65-year-old woman who developed BBF one month after hepatectomy and presented with refractory irritating cough accompanied by yellow bitter sputum. The diagnosis was confirmed through detection of bile components in the sputum, fiberoptic bronchoscopy examination, and endoscopic retrograde cholangio-pancreatography (ERCP). Unfortunately, both endobronchial blocker and endoscopic nasobiliary drainage (ENBD) failed to address the condition until surgical removal of the involved subdiaphragmatic fistula followed by pedicled greater omentum tamping were performed. After closure of the fistula during a 5-month follow-up period, she did not experience any further episodes of biloptysis.

CONCLUSIONS

For diathermy burn associated BBF, non-surgical management proves difficult due to inadequate or ineffective biliary drainage, so that early surgical intervention should be considered as an effective approach. Moreover, the adhesion between the atrophied liver and the diaphragm may pose a significant risk factor for diathermy burn, necessitating heightened vigilance.

Congenital bilio-bronchial fistula in an adult: a review of literature and video demonstration of laparoscopic fistula tract excision

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.