Bronchobiliary fistulae between a liver hydatid cyst and the middle lobe of the right lung

We report a case of bronchobiliary fistula between a liver hydatid cyst and the middle lobe of the right lung. It is also reviewed the etiology, pathogenesis, clinical features, diagnosis and treatment of bronchobiliary fistulas.     

The use of endoscopy to treat bronchobiliary fistula caused by choledocholithiasis

Bronchobiliary fistula is a rare disorder consisting of the formation of a passageway between the biliary ducts and the bronchial tree. We describe an 87-yr-old woman who had a bronchobiliary fistula secondary to obstruction caused by multiple common bile duct stones. The diagnosis was confirmed by the presence of bile in the sputum and transhepatic cholangiography. Successful stone extraction with balloon and basket techniques and endoscopic sphincterotomy decompressed the biliary tract and was followed by healing of the bronchobiliary fistula without surgical intervention, which has heretofore been considered the only successful means of treatment.     

Bronchobiliary fistula complicating oriental cholangiohepatitis

Bronchio biliary fistula in adults is a rare event defined by the passage of bile into the bronchus and the sputum (biloptysis).Typically these lesions occur in the congenital form, as a result of thoracoabdominal trauma, or in rare instances as a result of iatrogenic injury or long-standing biliary tract disease and obstruction. In this paper, we report a novel case of a fatal bronchobiliary fistula that developed in a 67-year-old Chinese male with Oriental cholangiohepatitis. To our knowledge, this is the first case report of a bronchobiliary fistula complicating the clinical management of a patient with this disease.     

Left hepatic duct injury and thoracobiliary fistula after abdominal blunt trauma

Thoracobiliary fistula after blunt hepatic trauma is rare. We report a case of pleurobiliary fistula after a blunt hepatic trauma leading to a left hepatic lobe laceration together with a left hepatic duct injury. The management of this traumatic lesion is discussed and related to the existing literature data. The diagnosis of traumatic thoracobiliary fistula rests upon clinical suspicion in the setting of a persistent right pleural effusion. Demonstration of the presence of bile in the pleural cavity by thoracocentesis is considered a proof of pleural biliary fistula. We think that laparotomy is an appropriate route for the treatment of pleurobiliary fistulas. However, when a bronchobiliary fistula is suspected, the patient should be treated with thoracotomy and may require pulmonary resection to remove the fistulous tracts.     

Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years

AIM:To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula(BBF).METHODS:Literature searches were performed in Medline,EMBASE,PHMC and LWW(January 1980August 2010)using the following keywords:biliobronchial fistula,bronchobiliary fistula,bronchobiliary fistula,biliarybronchial fistula,tracheobiliary fistula,hepatobronchial fistula,bronchopleural fistula,and biliptysis.Further articles were identified through crossreferencing.RESULTS:Sixtyeight cases were col...     

Bronchobiliary fistula due to alveolar hydatid disease

Bronchobiliary fistula is a serious complication of echinococcosis of the liver. Surgical and endoscopic treatments have been used successfully in the management of bronchobiliary fistula due to hepatic hydatid cysts. However, very little information exists on the management of bronchobiliary fistula due to alveolar hydatid disease. We report here the efficacy of various potential therapies in three cases.     

Chronic cough due to bronchobiliary fistula.

Bronchobiliary fistula is a rare cause of chronic cough. Here we describe a 70-year-old woman complaining of chronic cough and copious dark-yellow watery sputum. The presence of air in the biliary tract in the lower cuts of a computerized tomography scan of the chest and positive bile in the sputum led to the suspicion of bronchobiliary fistula. The diagnosis was confirmed by percutaneous transhepatic cholangiography. Drainage of the intrahepatic biliary tract resulted in complete resolution of her symptoms.     

Hepatopulmonary Fistula: Treatment with Biliary Metallic Endoprosthesis

Hepatopulmonary communication, most commonly in the form of bronchobiliary fistula, is an unusual lesion that can occasionally close spontaneously, but usually requires surgical therapy. The usual treatment has been a combined thoracoabdominal approach with correction of the fistulous tract or an abdominal approach to correct the causative bile duct obstruction. Both endoscopic and percutaneous therapy of the biliary ductal system have been described as forms of treatment. We present a case of hepatopulmonary fistula in a patient with bilioptysis, treated with percutaneous biliary metallic endoprosthesis. To our knowledge, this is the first reported case in which metallic stents were used to treat a hepatopulmonary fistula.     

Congenital bronchobiliary fistula in a 65-year-old woman

Congenital bronchobiliary fistula (CBBF) is quite a rare malformation and the diagnosis is usually made within a few hours or years from birth because of lower respiratory diseases beginning from early infancy. Surgical repair is necessary. Of the 29 cases reported, 4 occurred in adults aged 22-32 years. We detected CBBF incidentally in a 65-year-old woman. During bronchoscopy and thoracic computed tomographic study of the pulmonary nodules, we found an accessory bronchus descending from the carina and composed of a dark green secretion that contained 10% bilirubin. Drip infusion cholangiography revealed air in the left bile duct. Cholescintigraphy showed dilatation of the left bile duct and radiotracer pooling at the top edge of the left hepatic lobe. These findings indicated a narrow fistula between the airway and biliary duct. We attributed the patient's long survival without major complications to the narrowness of the communication. To our best knowledge, this is the fifth and oldest reported adult diagnosed with CBBF.     

Intrahepatic Spontaneous Arterioportal Fistula: Duplex Ultrasound Diagnosis and Angiographic Treatment

A 54-yr-old male with portal hypertension received ineffective medical therapy for the diagnosis of portal hepatic cirrhosis. Duplex ultrasound (US) revealed pulsatile arterial flow in the right main portal vein. The correct diagnosis of intrahepatic arterioportal fistula was established and confirmed by angiography. Right hepatic artery embolization with three coils was performed. The patient is alive for 16 months after the embolization, and his complaints have disappeared. There has been full resorption of ascites and absence of varices. Nine previously reported similar cases are reviewed.     

Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis

Renal sodium and water retention and plasma volume expansion have been shown to precede ascites formation in experimental cirrhosis. The classical "underfilling" theory, in which ascites formation causes hypovolemia and initiates secondary renal sodium and water retention, thus seems unlikely. While the occurrence of primary renal sodium and water retention and plasma volume expansion prior to ascites formation favors the "overflow" hypothesis, the stimulation of the renin-angiotensin-aldosterone system, vasopressin release and sympathetic nervous system associated with cirrhosis is not consonant with primary volume expansion. In this present article, the "Peripheral Arterial Vasodilation Hypothesis" is proposed as the initiator of sodium and water retention in cirrhosis. Peripheral arterial vasodilation is one of the earliest observations in the cirrhotic patient and experimental animals with cirrhosis. Arterial vasodilators and arteriovenous fistula are other examples in which renal sodium and water retention occur secondary to a decreased filling of the arterial vascular tree. An increase in cardiac output and hormonal stimulation are common features of cirrhosis, arteriovenous fistula and drug-induced peripheral arterial vasodilation. However, a predilection for the retained sodium and water to transudate into the abdominal cavity occurs with cirrhosis because of the presence of portal hypertension. The Peripheral Arterial Vasodilation Hypothesis also explains the continuum from compensated to decompensated cirrhosis to the hepatorenal syndrome.     

Arterioportal Fistula: a Rare Cause of Portal Hypertension and Abdominal Pain

Esophageal varices are commonly caused by portal hypertension secondary to cirrhosis. We report the case of a 71-year-old woman who presented with esophageal variceal bleeding due to portal hypertension caused by an arteriovenous fistula. The fistula, which was probably brought about by a liver biopsy performed 18 years previously, was complicated by bleeding. Since this event, the patient has reported right upper quadrant pain. Embolization resulted in elimination of the varices as well as abdominal discomfort.     

Arterioportal fistula: a rare cause of portal hypertension and abdominal pain.

Esophageal varices are commonly caused by portal hypertension secondary to cirrhosis. We report the case of a 71-year-old woman who presented with esophageal variceal bleeding due to portal hypertension caused by an arteriovenous fistula. The fistula, which was probably brought about by a liver biopsy performed 18 years previously, was complicated by bleeding. Since this event, the patient has reported right upper quadrant pain. Embolization resulted in elimination of the varices as well as abdominal discomfort.     

Carotid cavernous fistula in a patient with Graves' ophthalmopathy

The clinical manifestations of carotid cavernous fistula, an abnormal arteriovenous connection between the cavernous sinus and the carotid artery, can closely mimic the cardinal signs of Graves' ophthalmopathy, an inflammatory disorder of the orbit usually associated with autoimmune thyroid disease. Therefore, carotid cavernous fistulas are generally considered in the differential diagnosis of Graves' ophthalmopathy, especially when the eye involvement is unilateral or asymmetric, and there is the need for exclusion of rarer etiologies of orbital disease. This is the first report of the simultaneous occurrence of Graves' ophthalmopathy and carotid cavernous fistula. The patient was a 67-yr-old woman who presented with a history of Graves' disease with mild bilateral ophthalmopathy treated with radioiodine following a 10-yr therapy with methimazole; after radioiodine treatment, ophthalmopathy deteriorated. At the time of our initial clinical evaluation the ocular involvement of the patient was symmetric, and no evidence of any associated condition was found. However, the response of eye disease to corticosteroid treatment was markedly unequal, resulting in evident asymmetry. This prompted a reconsideration of the diagnosis and a new evaluation of the patient with sensitive techniques, leading to the further diagnosis of carotid cavernous fistula.     

Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: a case report and review of the literature.

An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.     

Aortoduodenal fistula as a cause of gastrointestinal bleeding--difficulties in endoscopic diagnosis

We report on three patients with severe gastrointestinal bleeding arising from aortoenteric fistula. Two patients presented with a secondary aortoduodenal fistula. In the first case bleeding occurred 8 months after aortobifemoral graft implantation. In the second patient aortobiliacal graft implantation was performed 22 years before. In the third case the aortoenteric fistula was primary and was caused by an abdominal aortic aneurysm without prior vascular intervention. In the first case diagnosis was made by urgent endoscopy visualizing ongoing bleeding from the duodenal fistula. In the two other patients urgent endoscopy and CT as well could not demonstrate the bleeding source. Aortoenteric fistula was diagnosed endoscopically during severe rebleeding some hours later. Two patients underwent surgery with implantation of an axillobifemoral bypass; the third patient declined further intervention and died. The course shows that aortoduodenal fistula can present with severe but intermittent gastrointestinal bleeding making the diagnosis in the non-bleeding interval difficult. In patients with severe gastrointestinal bleeding and a history of aortic disease (aneurysm, prior aortic graft repair or stenting) an aortoduodenal fistula should be suspected and the indication for surgical intervention should be considered early in spite of negative results of endoscopy and CT.     

Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding.     

Scrotal oedema in a kidney graft recipient

A 54-year old man received a cadaveric renal allograf for end-stage renal disease due to membranous nephropathy. The patient developed scrotal oedema, 14 days after renal transplantation. The biochemical analysis of scrotal fluid after surgical drainage demostrated urine. Helical computed tomography was performed and it showed contrast leaks in medial, distal ureter and bladder. The urinary fistula was treated with surgical repairment and catheter endoluminal of ureter which was retired in four weeks. The incidence of urinary fistula ranged from 3 to 9%. The scrotal or perineal oedema is unusual clinical presentation of urinary leaks. The diagnosis of urinary fistula may be difficult and depends on a high degree of clinical suspicion. The helical computed tomography is a technique which allows a high resolution three-dimensional reconstruction and it can be used to make the diagnosis of urinary fistula.     

Fatal hemobilia resulting from an iatrogenic arteriobiliary fistula as a rare complication of transjugular liver biopsy

Transjugular liver biopsy is an important tool for diagnosing and/or staging of advanced liver disease. This procedure is considered safe even in the presence of severe coagulopathy, although rare fatal complications have been described. We herein report the first case of fatal hemobilia after transjugular liver biopsy. A patient with alcoholic liver cirrhosis developed hematemesis 1 day after transjugular liver biopsy. Upper gastrointestinal endoscopy revealed bleeding from the papilla of Vater. Despite early intervention by angiography and embolization of an arteriobiliary fistula, the patient deteriorated and ultimately died due to multiorgan failure.     

Congenital bronchoesophageal fistula in an adult： A case report

Bronchoesophageal fistulas are usually diagnosed in the neonatal period. As such, the condition is rare in adults. We present a case of a congenital bronchoesophageal fistula in a 62-year-old man with the complaint of severe bouts of cough and choking after swallowing liquid. His workup included a barium esophagogram that revealed a fistula between the esophagus and a right lower lobe bronchus. The diagnosis should be considered in certain individuals with suggestive symptomatology and unexplained respiratory pathology. The fistula was divided and resected, The patient had an uneventful recovery.