Scientific Letter
Bronchobiliary Fistula, a Late Complication of Liver Surgery
Fístula biliobronquial, una complicación tardía de la cirugía hepática
Mario Miranda García
, Alí Martakoush María, María Cobos Briz
Corresponding author
Servicio de Urgencias, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain
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"tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "285" "paginaFinal" => "286" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mario Miranda García, Alí Martakoush María, María Cobos Briz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Mario" "apellidos" => "Miranda García" "email" => array:1 [ 0 => "mariomiranda7@hotmail.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alí" "apellidos" => "Martakoush María" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Cobos Briz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urgencias, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fístula biliobronquial, una complicación tardía de la cirugía hepática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1139 "Ancho" => 1500 "Tamanyo" => 221468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiplanar coronal CT reconstruction slices with intravenous contrast medium. (A) Fistulous tract between the biliary tree and the bronchus of the right lower lobe. (B) Right subphrenic collection. (C) Subhepatic collection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchobiliary fistula is an abnormal communication between the bile duct and the bronchial tree. In 1850, Peacock described the first case in a 20-year-old woman with hepatic echinococcosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It is a rare entity,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and few cases have been reported in the literature. Morbidity and mortality are high, and the diagnosis is essentially clinical, guided by the pathognomonic presence of biliptysis, or bile in the sputum.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Bile has a corrosive effect on the lung and pleural space.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 57-year-old man who presented in the emergency room with a 3-day history of fever 38.5<span class="elsevierStyleHsp" style=""></span>°C and bilous expectoration. Significant history included sigma adenocarcinoma with liver metastases, for which he received neoadjuvant chemotherapy with irinotecan and cetuximab. Portal vein embolization and surgical resection of the liver metastasis (right hepatectomy, section of segment 4 A, and left lobe), cholecystectomy and splenectomy were subsequently performed. He received single-agent cetuximab until sigmoidectomy with colorectal anastomosis, which was performed 8 months before he presented in the emergency room. At that time, the sigma cancer was in remission (CEA 3.9<span class="elsevierStyleHsp" style=""></span>ng/ml), and the patient was being treated with cetuximab every 15 days. On physical examination, arterial blood pressure was 130/80<span class="elsevierStyleHsp" style=""></span>mmHg, heart rate 115<span class="elsevierStyleHsp" style=""></span>bpm, temperature 37.5<span class="elsevierStyleHsp" style=""></span>°C, and oxygen saturation 89%. Poor general condition, conjunctival icterus, reduced breath sounds in the right field with crackles, and hepatomegaly of 2 finger breadths. Clinical laboratory tests showed significant leukocytosis (25<span class="elsevierStyleHsp" style=""></span>790/μl) with neutrophilia (80%). Chest X-ray revealed consolidation in the right lower lobe. Given the likelihood of a biliopulmonary fistula as a late complication of liver surgery, a computed tomography (CT) of the chest-abdomen was requested, which showed parenchymal involvement in the right lower lobe due to a fistula between the right lower lung and the hepatobiliary and subphrenic space. Both the CT and the nuclear magnetic resonance cholangiography showed a large collection extending craniocaudally from the right hemithorax to the subhepatic region, measuring 16<span class="elsevierStyleHsp" style=""></span>cm. This was composed of a multiseptated subphrenic collection (7.5×12<span class="elsevierStyleHsp" style=""></span>cm) connecting with a subhepatic collection (4.5×4.5<span class="elsevierStyleHsp" style=""></span>cm) (bilioma) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Empirical antibiotic therapy began with a 12-day course of meropenem. Percutaneous cholangiography was performed, with placement of double external percutaneous biliary drainage in segments II and III. The procedure was incident-free.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the patient was initially transferred to the intensive care unit, his clinical and radiological course were very favorable with resolution of fever on day 3, improvement of respiratory failure, and resolution of radiological infiltrate. At discharge, he was prescribed a third-generation cephalosporin (cefixime) for 1 week. The follow-up chest-abdomen CT 11 days after discharge showed reduced involvement of the right lower lung, with some small residual image along the length of the fistula and reduced subphrenic collection (6.2×3.67<span class="elsevierStyleHsp" style=""></span>cm).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Bronchobiliary fistulas can be congenital or acquired. Acquired fistula occur due to 3 mechanisms:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Fistula due to trauma is the most frequent, caused by injuries penetrating the lung, diaphragm and liver. Bile duct surgery is included in this category, particularly laparoscopic interventions. In our case, the fistula was a secondary complication of previous liver surgery.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fistula due to liver disease, the most common causes being hydatid cyst and amebic liver abscess.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Fistula due to bile duct obstruction.</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">Recommended diagnostic procedures for bronchobiliary fistulas are percutaneous transhepatic cholangiography,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> bronchoscopy, 3-dimensional CT reconstruction,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and cholescintigraphy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Magnetic resonance imaging with contrast medium contributes functional data. There is no consensus regarding the therapeutic management of these fistulas; a review of the literature suggests reserving surgery for fistulas that do not respond to conservative treatment or for complicated cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García MM, María AM, Briz MC. Fístula biliobronquial, una complicación tardía de la cirugía hepática. Arch Bronconeumol. 2018;54:285–286.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1139 "Ancho" => 1500 "Tamanyo" => 221468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiplanar coronal CT reconstruction slices with intravenous contrast medium. (A) Fistulous tract between the biliary tree and the bronchus of the right lower lobe. (B) Right subphrenic collection. (C) Subhepatic collection.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Un caso raro de fístula biliobronquial. Revisión bibliográfica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Carrillo Muñoz" 1 => "T. Sánchez Valadez" 2 => "N. Gil Rojas" 3 => "F. Navarro Reynoso" 4 => "C. Núñez-Pérez Redondo" 5 => "R. 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Olivo Esteban" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2012" "volumen" => "104" "paginaInicial" => "210" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22537370" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022510X17301946" "estado" => "S300" "issn" => "0022510X" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000005/v1_201804290447/S1579212918300764/v1_201804290447/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005400000005/v1_201804290447/S1579212918300764/v1_201804290447/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918300764?idApp=UINPBA00003Z" ]
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| 2024 September | 40 | 25 | 65 |
| 2024 August | 73 | 41 | 114 |
| 2024 July | 53 | 37 | 90 |
| 2024 June | 68 | 36 | 104 |
| 2024 May | 73 | 25 | 98 |
| 2024 April | 45 | 35 | 80 |
| 2024 March | 48 | 20 | 68 |
| 2024 February | 41 | 11 | 52 |
| 2023 March | 12 | 4 | 16 |
| 2023 February | 71 | 19 | 90 |
| 2023 January | 62 | 24 | 86 |
| 2022 December | 67 | 33 | 100 |
| 2022 November | 56 | 26 | 82 |
| 2022 October | 72 | 48 | 120 |
| 2022 September | 58 | 28 | 86 |
| 2022 August | 49 | 52 | 101 |
| 2022 July | 49 | 46 | 95 |
| 2022 June | 89 | 52 | 141 |
| 2022 May | 82 | 34 | 116 |
| 2022 April | 62 | 32 | 94 |
| 2022 March | 76 | 48 | 124 |
| 2022 February | 67 | 32 | 99 |
| 2022 January | 86 | 53 | 139 |
| 2021 December | 62 | 54 | 116 |
| 2021 November | 55 | 41 | 96 |
| 2021 October | 61 | 61 | 122 |
| 2021 September | 77 | 49 | 126 |
| 2021 August | 62 | 34 | 96 |
| 2021 July | 50 | 30 | 80 |
| 2021 June | 77 | 35 | 112 |
| 2021 May | 82 | 42 | 124 |
| 2021 April | 168 | 115 | 283 |
| 2021 March | 107 | 39 | 146 |
| 2021 February | 67 | 26 | 93 |
| 2021 January | 50 | 21 | 71 |
| 2020 December | 42 | 22 | 64 |
| 2020 November | 44 | 27 | 71 |
| 2020 October | 41 | 22 | 63 |
| 2020 September | 49 | 24 | 73 |
| 2020 August | 48 | 23 | 71 |
| 2020 July | 41 | 28 | 69 |
| 2020 June | 39 | 11 | 50 |
| 2020 May | 52 | 18 | 70 |
| 2020 March | 14 | 5 | 19 |
| 2020 February | 51 | 20 | 71 |
| 2020 January | 56 | 24 | 80 |
| 2019 December | 33 | 14 | 47 |
| 2019 November | 39 | 22 | 61 |
| 2019 October | 25 | 11 | 36 |
| 2019 September | 32 | 9 | 41 |
| 2019 August | 48 | 38 | 86 |
| 2019 July | 55 | 27 | 82 |
| 2019 June | 91 | 14 | 105 |
| 2019 May | 66 | 19 | 85 |
| 2019 April | 45 | 14 | 59 |
| 2019 March | 48 | 20 | 68 |
| 2019 February | 37 | 12 | 49 |
| 2019 January | 48 | 24 | 72 |
| 2018 December | 53 | 21 | 74 |
| 2018 November | 60 | 26 | 86 |
| 2018 October | 6 | 4 | 10 |
Show all
