Successful Resection of Hepatocellular Carcinoma with Bronchobiliary Fistula Caused by Repeated Transcatheter Arterial Embolizations: Report of a Case

Hibi, Taizo; Sakamoto, Yoshihiro; Asamura, Hisao; Tochigi, Naobumi; Ojima, Hidenori; Shimada, Kazuaki; Sano, Tsuyoshi; Kosuge, Tomoo

doi:10.1007/s00595-006-3351-1

Cited by 17 publications

(8 citation statements)

References 16 publications

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“…In terms of diagnosis, CT imaging is usually the predominant modality or biliary scintigraphy with hepatic iminoacetic acid (HIDA) which demonstrates initial tracer activity in the liver which migrates into the chest cavity (12). BBF can also be diagnosed by interventional techniques, such as ERCP, percutaneous transhepatic cholangiography, bronchoscopy or fistulography (4,13,14).…”

Section: Discussionmentioning

confidence: 99%

Bronchobiliary fistula after hepatectomy: A case report and review of the literature

et al. 2019

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Bronchobiliary fistula (BBF) is a rare complication following hepatectomy, and consists of an abnormal intercommunication between the biliary tract and bronchial tree. The management of this rare entity is challenging with limited current evidence to date on how to treat this condition. Herein, a case of BBF following a central hepatectomy and the successive steps of the management was presented. Fourteen months postoperatively, the patient presented to the Oncology Department complaining of new onset fever and expectoration. A computerized tomography scan revealed a BBF and the patient was subsequently referred to our department for further treatment. The surgical team decided that a further operation was required. Using the transabdominal approach, a communication between the initial intrahepatic collection and one inferior lobular bronchus was revealed. Transhiatal removal of fistula was performed with closure of the defect through the abdomen. There was no bile leak through the remaining liver parenchyma. Multidisciplinary management should be considered, taking into consideration the underlying pathology leading to this rare complication. Conservative treatment should be considered first, while surgical resection of the BBF remains an option when other therapies have failed. Surgeons should be aware of this rare complication bile duct injuries during hepatic operations can cause.

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Section: Discussionmentioning

confidence: 99%

Bronchobiliary fistula after hepatectomy: A case report and review of the literature

et al. 2019

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“…The pathogenesis of a BBF is generally considered to include the following: the mechanical effects of increased intraluminal pressure on the biliary system due to obstruction of the bile duct and the presence of local inflammatory or infectious processes, such as a subphrenic or liver abscess [14, 15]. Clinically, the presence of bilioptysis is a pathognomonic sign of BBF [16, 17], and a definitive diagnosis can be made by ERC, bronchoscopy, or percutaneous transhepatic cholangiography [6, 14, 18]. Bilioptysis led us to suspect a BBF in our patient because it has been reported that bilioptysis is seen in all BBF patients.…”

Section: Discussionmentioning

confidence: 99%

Bronchobiliary fistula caused after hepatectomy for hepatocellular carcinoma: a case report

et al. 2016

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BackgroundA bronchobiliary fistula, an intercommunication between the biliary tract and bronchial trees, is an extremely rare complication after hepatectomy.Case presentationA 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.ConclusionsWe 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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“…However, surgery for BBF in a patient, who has undergone liver resections and who is in a state of sepsis, could add to the negative sentiments for retrieval. 3 , 7 Nonsurgical treatments such as radiological and endoscopic interventions, which are less riskier than surgery, have been recently highlighted. In the previous cases, patients with BBF following RFA which are complicated by biloma or liver abscess successfully underwent external drainages with or without endoscopic drainage.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

Kim

Choi

et al. 2013

Korean J Hepatobiliary Pancreat Surg

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Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA), in which there is abnormal communications between the biliary tract and the bronchial trees. Surgery should only be considered for BBF when non-invasive interventions have failed. In this report, we describe the surgical management for BBF when complicated by an abscess that was encountered after RFA in a 52-year-old woman with recurrent hepatocellular carcinoma (HCC). She had previously undergone central bisectionectomy of HCC 7 years ago, and had been treated with a sixth transarterial chemoembolization and first RFA for recurrent HCC after the operation. After the liver abscess and BBF occurred in the posterior section of the liver, she received posterior sectionectomy and hepaticojejunostomy, drainage of the lung abscess, diaphragmatic resection and repair because it was impossible to drain the abscess radiologically. Symptomatic improvements were being achieved through operative treatments where pleural effusion and pneumonic consolidation was obliterated on a 2-months follow-up image.

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Successful Resection of Hepatocellular Carcinoma with Bronchobiliary Fistula Caused by Repeated Transcatheter Arterial Embolizations: Report of a Case

Cited by 17 publications

References 16 publications

Bronchobiliary fistula after hepatectomy: A case report and review of the literature

Bronchobiliary fistula after hepatectomy: A case report and review of the literature

Bronchobiliary fistula caused after hepatectomy for hepatocellular carcinoma: a case report

Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

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