[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy]

Multimodal Approach to Acquired Bronchobiliary Fistula Secondary to Hepaticojejunostomy Stricture Following Yttruim-90 Therapy

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.

[Left localization of biliobronchial fistula: Exceptional complication of hepatic hydatidosis]

INTRODUCTION

The biliobronchial fistula of hydatic origin is a rare complication and the left localization is exceptional.

OBSERVATION

We report the case of a 26-year-old patient from the rural area who was referred to us for treatment of biliptysis. The thoracic and abdominal computed tomography diagnosed a left biliobronchial fistula was. Management consisted of primary endoscopic sphincterotomy, followed by left exclusive thoracotomy surgery to treat pulmonary, hepatic and diaphragmatic repair. The evolution was favorable with disappearance of the biliptysie.

CONCLUSION

The diagnosis of left biliobronchial fistula requires a precise assessment not only by the imagery but also the bronchial fibroscopy allowing the acurate localisation of the lesion before any surgical enterprise.

Bronchobiliary fistula after multiple transcatheter arterial chemoembolizations for hepatocellular carcinoma: A case report

Bronchobiliary fistula (BBF) is a rare condition, defined as an abnormal communication between the bronchial system and the biliary tree. Patients with this condition usually present with massive biliptysis, and the mortality rate is high. BBF has been reported to occur in patients with congenital conditions, complications of trauma, hepatic abscesses and biliary tract obstruction (surgical as well as non-surgical). However, to the best of our knowledge, BBF as a complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) has not been reported to date. We herein report a case of BBF developing as a complication following TACE in a 71-year-old male patient with HCC. The patient was treated by placement of a metallic biliary stent followed by percutaneous transhepatic biliary drainage to decompress the intrahepatic biliary tree, and his symptoms were immediately relieved.

[The thoracic surgeon and the management of the bronchial biliary fistula of hydatid origin]

INTRODUCTION

The bronchial biliary fistula surgery is a major one, always going with a higher rate of complication especially in case of bile duct obstruction. The aim of this study is to find out the contribution of endoscopic sphincterotomy while reporting the results of surgical treatment of bronchial biliary fistulae by exclusive thoracotomy.

METHODS

This was a retrospective study, which took place in the Department of Thoracic Surgery, University Hospital Hassan II, from January 2009 to March 2016. The parameters studied in connection with the bronchial biliary fistula of hydatid origin were: age, sex, origin, history of surgery especially for hepatic hydatid cyst, term of bilyptysie, imaging results, preoperative cholangiography indications, surgical treatment modalities and patients trends.

RESULTS

A sample of 12 patients was included (6 men and 6 women) with an average age of 44 years old, with a gap spanning between 17 and 81 years. Seven patients had at least a history of hepatic hydatid surgery. The biliptysie was the main symptom in 8 patients. A biological cholestasis syndrome was found in 6 patients. The thoracoabdominal CT scan performed on all patients comes out with results in 100% of cases. Four patients received endoscopic retrograde cholangiography that allowed them to release the bile duct completely by sphincterotomy with extraction of hydatid membrane in one patient and with development of a biliary stent in another patient. The incision was a low posterolateral thoracotomy in 10 patients that went under surgery. It has allowed to deal in one-time liver and lung injuries combined with diaphragmatic breach repair. Inside the group of patients that went under surgery, the postoperative results were simple in 8 cases. We have noted an overall mortality rate of 18.2%.

CONCLUSION

Bronchial biliary fistula surgery complications remains considerable despite the progress of diagnostic imaging. Preoperative endoscopic sphincterotomy is a milestone in the handling of this surgery. It may even be suggested as exclusive therapy in inoperable patients with significant biliptisy.

Combined thoracic and hepatobiliary surgery for iatrogenic bronchobiliary fistula

Bronchobiliary fistula is a rare pathology mainly caused by hepatic tumors, bile duct obstruction, or hepatic hydatid disease. A 70-year-old man developed a bronchobiliary fistula after biliary stenting. After failure of conservative treatment including endoscopic retrograde biliary drainage, he underwent a combined operation with a two-level approach. Both a thoracotomy and laparotomy were performed, allowing pulmonary resection, diaphragmatic repair, and bile duct reconstruction during the same operation. Postoperative follow-up at one year showed optimal healing of the fistula.

Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era. Gastroenterol Res Pract. 2016;2016:6293538. [PMID: 26819608 PMCID: PMC4706943 DOI: 10.1155/2016/6293538]

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

[Bilio-bronchial fistula due to hydatic disease: case report and review of the literature]

Bilio-bronchial fistula due to hydatid disease is a rare but severe condition. Three levels, abdominal, diaphragmatic and thoracic, may be involved, with high perioperative mortality. We report a case of bilio-bronchial fistula successfully managed by thoracotomy. Thoracotomy is the best approach for surgical treatment at all three levels.

Cutaneous bronchobiliary fistula treated with Tissucol sealant

Bronchobiliary fistula is a rare and is an uncommon but severe complication of hydatid disease of the liver. Treatment has traditionally been surgical resection, but embolization and stent placement have been described. The invasive method seems to be a key component of patient treatment. We describe a case of a 58-year-old woman who, 25 years before, had undergone surgery for a hydatid cyst. A total cystectomy without previous puncture or parasite extraction was carried out. The lower aspect of the cyst was found to be completely perforated over the biliary duct. During the postoperative course, the patient had subphrenic right-sided pleural effusion and biliary fistula that subsided with medical treatment. Afterward, the patient came to the outpatient area of our hospital complaining of leakage of purulent exudate through the cutaneous opening, pain located on the right hypochondrium radiating to the right hemithorax, malaise, fever, chronic cough, and occasional vomiting of bile. Fistulography revealed an anfractuous cavity communicating with a residual cystic cavity on the right hepatic lobe. We observed communication with the intrahepatic canaliculi. Computed tomographic scan revealed a fistulous tract on the anterior liver border through the abdominal wall. There were no posttreatment complications. The patient is asymptomatic.

[Bilateral hydatid bilio-bronchial fistula]

INTRODUCTION

Bilio-bronchial fistula of hydatid origin is a rare but serious complication of hepatic hydatid cyst, the treatment of which is now well established.

CASE REPORT

We report a case of bilateral bilio-bronchial fistula, successfully managed by bilateral thoracotomy with an interval of one week, and complicated by dyspnoea that resolved quickly.

CONCLUSION

If the indication for thoracotomy is indisputable in case of unilateral bilio bronchial fistula, an initial laparotomy should be considered in the case of bilateral bilio-bronchial fistula.

Successful treatment of intractable bronchobiliary fistula using long-term biliary stenting

A bronchobiliary fistula (BBF) is an uncommon entity with bilioptysis being a pathognomonic sign. We describe the case of a 41-year-old man who had recurrent BBF, 6 months after resection of the anterior segment of the right lower pulmonary lobe and repair of a BBF due to hepatic hydatid disease. Magnetic resonance cholangiography revealed a communication between the biliary tree and the lower lobe of the right lung. Endoscopic biliary sphincterotomy and repeated insertion of large size biliary plastic stents led to a successful resolution of the symptoms and closure of the fistula.

Bronchobiliary fistula treated by self-expanding ePTFE-covered nitinol stent-graft

A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula.

Classification of hydatid liver cysts

A number of investigations advocate various classification systems for liver hydatid cysts. However, none permits predicting the treatment outcome or making clinical decisions regarding medical treatment; open surgery; punction, aspiration, injection, reaspiration (PAIR); or laparoscopy. An international hydatid disease registry employing an uniform nomenclature and consistent reporting methods would allow more rational comparison of different management strategies. TN(R)C (topography, nature, recurrent, complication) classification is a comprehensive system based on four criteria: location (T), natural history (N), recurrence (R) and complications (C) of the cyst. This pictorial review illustrates the classification and puts accent of its clinical usefulness. The TN(R)C classification provides a standardized description formula of every liver hydatid cyst, permitting multiple comparisons and analyses.