Two cases of bronchobiliary fistula: Case report

Shim, Jae Ryong; Han, Sung‐Sik; Park, Hyung Min; Lee, Eung Chang; Park, Sang-Jae; Park, Joong-Won

doi:10.14701/ahbps.2018.22.2.169

Cited by 12 publications

(17 citation statements)

References 9 publications

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“…Recently, the number of nonsurgical approaches that involve drainage of bile via endoscopic and percutaneous biliary stenting has increased. [8–10] Surgical approaches with drainage of the subdiaphragmatic abscess with or without resection of the fistula and involved lung should be considered if other medical approaches have failed or when there are complications from underlying disease. [3] The combined approach uses drainage of bile (ERBD or PTBD) and abscess (ultrasound or CT- guided) followed by surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy

Lee

Jung²,

Lee³

et al. 2019

Medicine

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Rationale: Perioperative management of patients with bronchobiliary fistula (BBF) is an anesthetic challenge because they typically exhibit poor lung function preoperatively, require meticulous lung isolation intraoperatively and need postoperative respiratory support. Patient concerns: A 44-year-old man with a past surgical history of pancreaticoduodenectomy presented fluctuating fever, jaundice, dyspnea and yellowish sputum. Despite intravenous antibiotic treatment and repeated percutaneous drainage, patient showed gradual deterioration with hypoxemia, and uncontrolled pneumonia. Diagnoses: The patient was diagnosed with BBF based on the clinical manifestation such as biloptysis with pneumonia, and imaging studies. Interventions: Resection of the fistula and bilobectomy was performed under general anesthesia. Avoidance of positive pressure ventilation before lung isolation and precise lung isolation are essential for patients with BBF to protect the unaffected lung. Therefore, rapid sequence induction was performed. Left-sided double-lumen tube was inserted for lung isolation and position of the tube was confirmed by visualization with fiberoptic bronchoscopy. Bile-stained secretion was repeatedly suctioned in trachea and both bronchi during surgery. Outcomes: In spite of decrease in SpO 2 with institution of one-lung ventilation, the patient's oxygenation was gradually improved as surgery progressed without hemodynamic instability. At the end of surgery, the double-lumen tube was replaced with a single-lumen endotracheal tube for postoperative mechanical ventilation. Lessons: Absolute lung isolation using double-lumen tube for one-lung ventilation and bronchial toilet during surgery and replacement of single-lumen tube for postoperative respiratory support at the end of surgery are effective to improve oxygenation in patients with BBF.

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Section: Discussionmentioning

confidence: 99%

Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy

Lee

Jung²,

Lee³

et al. 2019

Medicine

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“…Right upper quadrant abdominal pain and chest pain can occur. Anemia, vomiting, hepatic decompensation and portal hypertension are sporadically reported [2,10,11].…”

Section: Clinical and Imaging Findingsmentioning

confidence: 99%

“…When possible, non-surgical or conservative interventions should be performed, such as ERCP biliary drainage, percutaneous ultrasound / CT guided drainage of the subdiaphragmatic or intrahepatic abscess, or bronchoscopy guided fistula embolization [2,6], but the success of these methods depends on the status of the inflammatory process [15]. Despite conservative methods are gradually consolidating, surgery remains mostly the only effective option [2,6,10], especially for the treatment of chronic fistulas associated with pulmonary failure or sepsis [15].…”

Section: Treatment and Prognosismentioning

confidence: 99%

Spontaneous bronchobiliary fistula: Case report

2020

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Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence of bile in the sputum as pathognomonic symptom, and it is often associated with suspicious pneumonia. The most common causes include infections (e.g. echinococcosis), hepatobiliary surgery, blunt torso traumas, tumors and percutaneous transhepatic procedures. Opinions about BBF treatment are still controversial as it can be treated by both conservative and surgical procedures, while pharmacological treatments are only rarely used. This case report presents a patient who had been diagnosed with chronic BBF of unknown cause, underwent several ineffective conservative procedures and was at last surgically treated.

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“…BBF, despite being rare, is known to be caused by different causes: congenital, malignancies, abscesses, traumatic, or iatrogenic [4,6]. Diagnosis is usually made clinically for biliptysis and it is sometimes inappropriately diagnosed as pneumonitis or chronic cough with greenish sputum [2] [7].…”

Section: Case Presentationmentioning

confidence: 99%

“…Definitive treatment for BBF has not yet been established. Surgical or non-surgical interventional procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic drainage (PTD), are frequently used as direct photographic evidence and management [9].. Transhepatic embolization, bronchoscopic injection of nbutyl cyanoacrylate, or histoacryl embolization has been tried [4,7]. A systematic review done on 68 cases had reported that interventional procedures were slightly more effective than surgical procedure (97% vs. 85%) [2].…”

Section: Case Presentationmentioning

confidence: 99%

Biliptysis

Elbahr¹

2019

Egypt Liver Journal

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Background: Biliptysis means coughing of bile which is a presenting symptom of a rare condition called bronchobiliary fistula (BBF). BBF is a connection between the biliary tract and bronchial tree. BBF mostly occurs secondary to malignancy, liver abscess, and trauma. Surgical approach in BBF management was the main management strategy, then endoscopic approach. Case presentation: We managed our first encountered case of biliptysis endoscopically by endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: ERCP management seems to be effective in management of biliptysis.

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Two cases of bronchobiliary fistula: Case report

Cited by 12 publications

References 9 publications

Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy

Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy

Spontaneous bronchobiliary fistula: Case report

Biliptysis

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