Biliobronchial Fistula after Liver Surgery for Giant Hydatid Cyst

Abstract

Background. Biliobronchial fistula (BBF) is a rare complication in the natural history of liver hydatid disease by Echinococcus granulosus. We present a case of BBF after resection of a giant liver hydatid cyst in a 72-year-old woman. Case Report. A total cystpericystectomy was done, leaving the left lateral section of the liver that was fixed to the diaphragm. Postoperatively, the patient developed obstructive jaundice. An ERCP showed an obstruction at the junction of the left biliary duct and the main biliary duct and contrast leak. At reoperation, the main duct was ischemic, likely due to torsion along its longitudinal axis. A hepatotomy was done at the hilar plate, and the biliary duct was dissected and anastomosed to a Roux-en-Y jejunal loop. She was discharged without complications. Five months later, the patient developed cholangitis and was successfully treated with antibiotics. However, she suffered repeated respiratory infections, and four months later she was admitted to the hospital with fever, cough, bilioptysis, and right lower lobe pneumonia. The diagnosis of BBF was confirmed with 99mTc Mebrofenin scintigraphy. At transhepatic cholangiography, bile duct dilation was seen, with a biliothoracic leak. She underwent dilatation of cholangiojejunostomy stricture with placement of an external-internal catheter. The catheter was removed 3.5 months later, and two years later the patient remains in very good condition. Conclusion. An indirect treatment of the BBF by percutaneous transhepatic dilation of the biliary stenosis avoided a more invasive treatment, with satisfactory outcome.

Hydatid cyst: Introducing a new surgical approach towards hepato-pulmonary fistula, a case report

“…One of the major complications of the hydatid cyst of the liver is its rupture into the pleura and bronchial tree. This happens either due to the pressure from the expanding hydatid cyst leading to erosion into the diaphragm or from the destructive effect of a superimposed infection [7] . The most prominent sign is bilioptysis.…”

Fístula biliobronquial tardía asociada a neumotórax

“…Sin embargo, la broncoscopia ha sido la más utilizada (52%) como método diagnóstico, seguida por la colangiografía y la broncografía. Otras modalidades menos utilizadas para el diagnóstico de FBB es mediante colangiografía percutánea, resonancia magnética colangiopancreatográfica, exploración con ácido iminodiacético hepatobiliar, colescitografia por tomografía con emisión de positrones y el examen de esputo para bilirrubina [11][12][13] .…”

Bilioptysis associated with alcohol hepatitis without evidence of bronchobiliary fistula: A rare case report

“…Most commonly, this finding has been associated with bronchobiliary fistula that can occur as a periprocedural complication, such as following surgery 1,2 or procedural management of hepatocellular carcinoma 3–5 . Other bronchobiliary fistula cases have been described as associated with trauma, 6,7 liver abscess 8 or echinococcosis 9–11 . Cases of bilioptysis unassociated with bronchobiliary fistula are infrequently reported in the literature; often, the mechanism is attributed to capillary endothelial permeability injury that allows for bilirubin, a high‐molecular‐weight protein, to cross the endothelial membrane.…”

“… 3 , 4 , 5 Other bronchobiliary fistula cases have been described as associated with trauma, 6 , 7 liver abscess 8 or echinococcosis. 9 , 10 , 11 Cases of bilioptysis unassociated with bronchobiliary fistula are infrequently reported in the literature; often, the mechanism is attributed to capillary endothelial permeability injury that allows for bilirubin, a high‐molecular‐weight protein, to cross the endothelial membrane. We describe the case of a 36‐year‐old patient with severe alcoholic hepatitis presenting with bilioptysis in the absence of a bronchobiliary fistula.…”