Posttraumatic bronchobiliary fistulae due to foreign body remnants after  a road traffic injury: a case report

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.

Bronchobiliary fistulae as a complication of untreated pulmonary hydatid cyst presenting with bilioptysis: A report of two cases

“…The diagnosis should be based on clusters of clinical arguments, paraclinical evidence, and radiological evaluations 9 . Most of the time, patients with BBF develop accompanying symptoms, like abdominal pain, jaundice, chronic cough, pleuritic chest pain, and fever 4,10 . BBF can be misdiagnosed with pneumonia at first due to nonspecific respiratory symptoms.…”

“…Surgical and non‐surgical interventions are valid measures to treat patients with BBF diagnosis. It is worth mentioning that noninvasive approaches like ERCP, MRCP, and percutaneous transhepatic cholangiography (PTCD) are preferred over traditional surgical approaches in non‐complicated patients with less severe fistulas 4,5 Roy J Mukkada. and colleagues used endoscopy combined with cyanoacrylate glue and microcoils to treat a stent‐induced BBF 12 Tatjana N Adzić‐Vukičević.…”

“…Cystic echinococcosis (CE) is a universal endemic larval infection that mainly involves the lung and liver 1,2 but can occur in various organs 3 . Bronchobiliary fistulae (BBF) is a highly uncommon complication of untreated hydatid cyst, and patients mainly present with bilioptysis 4 . Clinical manifestation of bilioptysis can attain the diagnosis of BBF, and therapeutic options may include surgical or safer non‐surgical modalities 5 .…”

Efficacy of Tranexamic Acid in the Treatment of Massive Upper Gastrointestinal Bleeding: A Randomized Clinical Trial

“…Proton pump inhibitor (PPI) therapy is a non-invasive pharmacologic treatment, which reduces rebleeding, mortality, and the need for endoscopic interventions. Therapeutic endoscopy is considered the cornerstone of diagnosis and treatment of the underlying cause of GIB [ 16 , 17 ]. Antifibrinolytic agents including TXA have also been used for bleeding control in GIB.…”

A ciliated hepatic foregut cyst mimicking hydatid cyst treated with laparoscopic surgery; a case-report and review of literature

“…Originally, CHFC is derived from an abnormal detachment of esophageal buds during early embryonic development of the foregut and subsequent incorporation into the liver [2] . Interestingly, ciliated foregut cysts could affect any foregut-derivated organs including the pharynx, tracheobronchial tree, mediastinum, esophagus, stomach, parts of duodenum, pancreas, and liver [3] , [4] , [5] , [6] , [7] . Early treatment is recommended due to the possibility of malignant transformation mainly to squamous cell carcinoma.…”