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      Posttraumatic bronchobiliary fistulae due to foreign body remnants after  a road traffic injury: a case report

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          Abstract

          Background

          Bronchobiliary fistula is an extremely rare disease that involves abnormal communication between a hepatic segment and bronchial tree. It is mostly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma.

          Case presentation

          We experienced an extremely rare case of bronchobiliary fistula after motor vehicle accident. A 15-year-old Persian boy visited our clinic with chief complaints of persistent pleuritic chest pain, productive cough, weight loss, and fever for 2 months. Coronavirus disease 2019 reverse transcription polymerase chain reaction test was negative. Chest X-ray revealed hazy opacification of right lower lobe. Bronchoalveolar lavage for acid-fast bacillus came back negative. Thoracoabdominal computed tomography scan revealed a collection in segment VIII of the liver communicating with another 13 × 5 cm multiloculated collection in the lower lobe of the right lung, with air foci within the collection. Right posterolateral thoracotomy was performed with the impression of bronchobiliary fistula. Drainage of hepatic collection with debridement, diaphragmatic repair, and open decortication of lung followed by resection of the involved segment of the right lung was performed. Histopathologic evaluations revealed abscess formation in pulmonary tissue, and many multinucleated giant cells were seen that appear to be due to foreign body remnants after previous laparotomy surgery. The foreign body seemed to be the remnants of Surgicel absorbable hemostat.

          Conclusions

          Herein, we report an extremely rare case of a posttraumatic bronchobiliary fistula caused by remnants of Surgicel hemostatic agent. Bronchobiliary fistula is mainly caused by untreated hydatid cyst, liver abscess, iatrogenic stenosis, and, rarely, trauma. Migration and erosion of oxidized regenerated cellulose through the diaphragm seems to be the causative factor of bronchobiliary fistula in this patient.

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          Most cited references31

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          A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures.

          Karin Hellerhoff, A Meining, H Helmberger … (2002)
          The differential diagnosis of biliary strictures remains a challenge. This study evaluated magnetic resonance cholangiopancreatography (MRCP) as a new procedure in comparison with the established methods of diagnosis including ERCP or percutaneous transhepatic cholangiography (PTC), CT, and EUS. Fifty patients (21 men, 29 women, mean age 65.7 years) with jaundice but no pain suspected to have biliary strictures were enrolled in this prospective study. MRCP, ERCP/PTC, CT, and EUS were performed prospectively; images and videotapes (EUS) of these tests were reviewed blindly under standardized conditions. Reference standards for comparison were surgery, a biopsy confirming malignancy, or the clinical course during follow-up (at least 12 months) in cases without histopathologic proof of malignancy. Seven patients ultimately proved to have jaundice caused by parenchymal liver disease and 43 had a biliary stricture (17 benign, 26 malignant). Forty patients underwent all 4 imaging tests. There were 10 patients in whom patient-specific problems precluded some procedures but who were included in an intention-to-diagnose analysis. The sensitivity and specificity for diagnosis of malignancy in the 50 patients were as follows: 85% / 75% for ERCP/PTC, 85% / 71% for MRCP, 77% / 63% for CT, and 79% / 62% for EUS, with similar values in the 40 patients who underwent all 4 imaging methods. The combination of MRCP and EUS improved specificity. Although MRCP provides the same imaging information as direct cholangiography, it has limited specificity for the diagnosis of malignant strictures. In the differential diagnosis of biliary strictures, several tests including ERCP-guided tissue diagnosis are still required, and MRCP has only a limited clinical role.
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            Conservative management of thoracobiliary fistula.

            Bhugwan Singh, Jaynathan Moodley, Mohamed H Sheik-Gafoor … (2002)
            Thoracobiliary fistulas are rare manifestations of biliary disruption. Given their rarity it is not surprising that there is little consensus on the optimal management of thoracobiliary fistulas. Patients presenting with thoracobiliary fistulas over a 5-year period (1996 to 2001) were evaluated. Initial management was conservative with tube thoracostomy or drainage of sepsis when appropriate, or both; antibiotics and somatostatin were routinely administered. Endoscopic retrograde cholangiography was performed when symptoms persisted to delineate the thoracobiliary communication and undertake sphincteroplasty. Eight patients with a mean age of 31.9 years (range 15 to 42) were evaluated. Biliary effusion occurred in 3 patients after hepatic injury (n = 2) and percutaneous transhepatic cholangiography (n = 1). Bilioptysis occurred in 5 patients after hepatic abscess (n = 4) and hepatic injury (n = 1) The biliary effusion (n = 3) was successfully managed by endoscopic sphincterotomy in 2 patients; the third patient underwent urgent surgical biliary drainage. Bilioptysis (n = 5) was successfully managed in 3 patients; persistence of symptoms in 2 patients prompted surgical intervention. Thoracobiliary fistulas may be successfully managed using a conservative approach. Surgery should be reserved for persistence of symptoms after exhaustion of this approach.
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              Management of acquired bronchobiliary fistula: 3 case reports and a literature review

              Hatice Eryigit, Selahattin Oztas, Senol Urek … (2007)
              Bronchobiliary fistula (BBF), which often presents with bilioptysis, is an abnormal communication between the bronchial system and biliary tree. It is a complication associated with a high mortality rate and requires a well-planned management strategy. Although hydatid disease is still the leading cause, extensive surgical interventions and invasive procedures of the liver have altered the profile of patients in recent decades. This paper presents 3 cases of BBF and reviews the literature regarding the treatment options generally mandated by clinical presentation and the underlying disease.
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                Author and article information

                Contributors
                Ramin Shekouhi: shekouhi.ramin@gmail.com
                Journal
                Journal ID (nlm-ta): J Med Case Rep
                Journal ID (iso-abbrev): J Med Case Rep
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1752-1947
                Publication date (Electronic): 22 May 2021
                Publication date PMC-release: 22 May 2021
                Publication date Collection: 2021
                Volume: 15
                Electronic Location Identifier: 291
                Affiliations
                [1 ]GRID grid.508728.0, ISNI 0000 0004 0612 1516, Department of Surgery, , Lorestan University of Medical Sciences, ; Lorestan, Iran
                [2 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Colorectal Research Center, Department of Surgery, , Shiraz University of Medical Sciences, ; Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran
                Article
                Publisher ID: 2859
                DOI: 10.1186/s13256-021-02859-6
                PMC ID: 8139863
                PubMed ID: 34020706
                SO-VID: 6565648b-6bcb-410c-b00c-b7b6281db6d4
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 24 January 2021
                Date accepted : 12 April 2021
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Medicine
                Keywords: posttraumatic,bronchobiliary fistulae,hepatobiliary fistulae,case report
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: posttraumatic, bronchobiliary fistulae, hepatobiliary fistulae, case report

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