Bilioptysis – Two Case Reports of Broncho Biliary Fistula

ABSTRACT

Bronchobiliary fistula (BBF) is a tract between the biliary system and bronchial tree with the presence of bile in the bronchus and the sputum. They are rare but serious complications. In most cases, they are caused by hepatic or subphrenic abscesses, resulting from different conditions. Pulmonary symptoms dominate the clinical picture, and the main manifestations are chronic irritant cough, production of greenish sputum, bronchopneumonia, and dyspnea. The diagnosis of BBF can be confirmed by imaging procedures such as biliary scintigraphy with hepatobiliary iminodiacetic acid, percutaneous transhepatic cholangiography, or endoscopic retrograde cholangiopancreatography. Bronchoscopy can demonstrate the presence of bile in the bronchial tree and may delineate the site of fistula. The treatment strategy for patients with BBF and biliary tract obstruction is the reestablishment of bile drainage, which allows the fistula to heal by reducing intrabiliary pressure. We present two cases of biliary-bronchial fistula, one related to hepatic abscess and the other due to percutaneous transhepatic biliary drainage for common bile duct obstruction secondary to inoperable hilar cholangiocarcinoma.

KEYWORDS

Bilioptysis - bronchobiliary fistula - hepatobiliary iminodiacetic acid scan

• REFERENCES

• 1 Borrie J, Shaw JH. Hepatobronchial fistula caused by hydatid disease. The Dunedin experience 1952-79. Thorax 1981; 36: 25-8
• 2 Rose DM, Rose AT, Chapman WC, Wright JK, Lopez RR, Pinson CW. Management of bronchobiliary fistula as a late complication of hepatic resection. Am Surg 1998; 64: 873-6
• 3 Khandelwal M, Inverso N, Conter R, Campbell D. Endoscopic management of a bronchobiliary fistula. J Clin Gastroenterol 1996; 23: 125-7
• 4 Gerazounis M, Athanassiadi K, Metaxas E, Athanassiou M, Kalantzi N. Bronchobiliary fistulae due to echinococcosis. Eur J Cardiothorac Surg 2002; 22: 306-8
• 5 Chua HK, Allen MS, Deschamps C, Miller DL, Pairolero PC. Bronchobiliary fistula: Principles of management. Ann Thorac Surg 2000; 70: 1392-4
• 6 Chow S, Bosco JJ, Heiss FW, Shea JA, Qaseem T, Howell D. Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterotomy. Am J Gastroenterol 1997; 92: 1839-43
• 7 Sugiyama M, Atomi Y, Matsuoka T, Yamaguchi Y. Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury. Gastrointest Endosc 2000; 51: 42-4
• 8 Rauws EA, Gouma DJ. Endoscopic and surgical management of bile duct injury after laparoscopic cholecystectomy. Best Pract Res Clin Gastroenterol 2004; 18: 829-46
• 9 Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Zavos C, Chatzimavroudis G. et al. The role of endoscopic treatment in postoperative bile leaks. Hepatogastroenterology 2006; 53: 166-70
• 10 Bjorkman DJ, Carr-Locke DL, Lichtenstein DR, Ferrari AP, Slivka A, Van JDam. et al. Postsurgical bile leaks: Endoscopic obliteration of the transpapillary pressure gradient is enough. Am J Gastroenterol 1995; 90: 2128-33
• 11 Partrinou V, Dougenis D, Kritikos N, Polydorou A, Vagianos C. Treatment of postoperative bronchobiliary fistula by nasobiliary drainage. Surg Endosc 2001; 15: 758
• 12 Ragozzino A, De RosaR, Galdiero R, Maio A, Manes G. Bronchobiliary fistula evaluated with magnetic resonance imaging. Acta Radiol 2005; 46: 452-4
• 13 Ertugrul I, Köklü S, Köksal AS, Coban S, Basar O, Ibis M. et al. Treatment of bronchobiliary fistula due to an infected hydatid cyst by a nonsurgical approach. Dig Dis Sci 2004; 49: 1595-7
• 14 D’Altorio RA, McAllister JD, Sestric GB, Cichon PJ. Hepatopulmonary fistula: Treatment with biliary metallic endoprosthesis. Am J Gastroenterol 1992; 87: 784-6
• 15 Hunt JA, Gallagher PJ, Heintze SW, Waugh R, Shiel GR. Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas. Aust N Z J Surg 1997; 67: 424-7
• 16 Görich J, Rilinger N, Sokiranski R, Siech M, Vogel J, Wikström M. et al. Percutaneous transhepatic embolization of bile duct fistulas. J Vasc Interv Radiol 1996; 7: 435-8
• 17 Johnson MM, Chin RJr., Haponik EF. Thoracobiliary fistula. South Med J 1996; 89: 335-9