Successful endoscopic management of a persistent bronchobiliary fistula with Histoacryl^®/Lipiodol^® mixture

Abstract

Introduction A bronchobiliary fistula (BBF) following liver directed therapy (resection/ablation) is a rare complication in which an abnormal communication between the biliary tract and bronchial tree is formed. This case report describes the successful management of a persistent BBF following multiple liver wedge resections and microwave ablation in a patient with a metastatic neuroendocrine tumour of the terminal ileum. Case history A 69-year-old man presented with unexplained weight loss and was subsequently diagnosed with a neuroendocrine tumour of the terminal ileum and liver metastasis. Following elective right hemicolectomy and multiple bilobar liver wedge resections combined with liver microwave ablation, he developed an early bile leak. A month later, a right subphrenic collection was identified and four months following surgery, biloptysis was noted. Numerous attempts with endoscopic retrograde biliary drainage (ERBD) failed to achieve sufficient drainage. The patient was treated successfully with endoscopic injection of a mixture of Histoacryl glue (B Braun, Sheffield, UK) and Lipiodol (Guerbet, Solihull, UK). There was no evidence of the BBF one year following intervention. Conclusions This novel approach for persistent BBF management using endoscopic Histoacryl glue embolisation of the fistula tract should be considered either as an adjunct to ERBD or when biliary tract decompression by drainage and/or sphincterotomy fails, prior to proceeding with surgical interventions.

Biliothoracic Fistula after Microwave Ablation of Liver Metastasis : Literature Review

“…Conversely, cholangiography is the procedure of choice to identify the biliary leak. e combination of pathognomonic clinical symptoms, a history of recent locoregional liver procedure, and radiological imaging, guide the diagnosis [10,15,16]. e optimal treatment for TBF is far to be defined [7,16].…”

“…e combination of pathognomonic clinical symptoms, a history of recent locoregional liver procedure, and radiological imaging, guide the diagnosis [10,15,16]. e optimal treatment for TBF is far to be defined [7,16]. Although the surgical approach based on debridement and ductal repair has been long advocated [6,12], less-invasive treatments have recently developed [16][17][18].…”

“…Although the surgical approach based on debridement and ductal repair has been long advocated [6,12], less-invasive treatments have recently developed [16][17][18]. None of the patients with postablative TBF for liver metastasis described in the literature underwent surgery (Table 1) [14,[16][17][18][19][20]. e Emergency Medicine International conservative approach is aimed to decrease the pressure in the biliary tree and to prevent the flow of bile through the TBF, enhancing its closure [7].…”

Unusual endoscopic treatment of recurrent cough and pneumonia

“…1 2 This has been mainly performed by cyanoacrylate embolisation from the bronchial side and rarely from the biliary side of the fistula. [2][3][4] The main problem of cyanoacrylate application is the risk of retrograde embolisation. Therefore, we primarily used coils followed by cyanoacrylate application.…”

Successful endoscopic management of a malignant gastroretroperitoneal fistula

“…However, the management plan in that case included open laparotomy and multilevel surgical procedures. Pinsker et al 5 described a successful endoscopic management of a persistent bronchobiliary fistula. The fistula in that case resulted from surgeries that included hemicolectomy and multiple bilobar liver wedge resections.…”