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      Fístula biliobronquial secundaria a quiste hepático hidatídico en tránsito al tórax: Reporte de caso Translated title: Bronchobiliary fistula secondary to a hepatic hydatid cyst in transit to the thorax: Report of one case


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          Se reporta el caso de una paciente con fístula biliobronquial (FBB) debida a hidatidosis hepática (HH) en tránsito al tórax que consultó por biliptisis y falla respiratoria aguda secundaria. Por el cuadro clínico sumado a los hallazgos de la ecografía de urgencia y el deterioro respiratorio progresivo se decidió operar a la paciente de urgencia, con la idea de controlar la vía aérea y realizar el tratamiento quirúrgico definitivo. Se eligió la vía abdominal para abordar el quiste hepático y su complicación. La evolución clínica de la paciente fue favorable, encontrándose asintomática, con radiografía de tórax normal y ecografía abdominal sin signos de cavidad residual en el control de los seis meses postoperatorios

          Translated abstract

          We report a 49 years old female presenting with productive cough, expectoration of purulent bile and respiratory failure. An emergency ultrasound showed a lesion with mixed echogenicity in the right hepatic lobe with dilatation of intra and extrahepatic biliary tract. The patient was operated and an abscessed hydatid cyst was found, with a fistula communicating with the right lower lung lobe. A partial cystectomy and choledocostomy was performed. The postoperative evolution was satisfactory and six months after operation, the patient is asymptomatic and her chest X ray and abdominal ultrasound are normal

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          Most cited references30

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          Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus.

          The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts. Eighty-four patients with liver hydatid cysts underwent an operation at the Geneva University Hospital between 1980 and 1999. Clinical presentation, postoperative morbidity, mortality, and long-term recurrence rate were evaluated. Among the 84 patients with liver hydatid disease, 35 patients (41%) presented complicated cysts (ie, cysts that had developed a fistula into adjacent structures or organs). In most patients, the fistula communicated with the biliary tree (n = 25), but we also observed communication with the right lung (n = 3), the right diaphragm (n = 2), liver parenchyma (n = 1), and peritoneal cavity (n = 1). Complete removal of the cystic disease was possible in 24 of 35 patients (70%). In 11 patients, fragments of cysts were not removed because of their location adjacent to main vessels. Postoperatively, 8 patients (23%) developed a severe complication (grade II and III). There were no postoperative deaths, and no recurrences of hydatid disease were observed with a median follow-up of 8.6 years (complete follow-up was obtained in 69% of patients). Complicated liver hydatid disease is frequent and was observed in almost half of patients operated for liver hydatid cysts at our center. Using a surgical strategy aimed at complete removal of cystic and pericystic tissue with simultaneous treatment of the fistulous tract, we observed 23% postoperative morbidity, no mortality, and no recurrence of disease with a median follow-up of >8 years.
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            Bronchobiliary fistula after radiofrequency thermal ablation of hepatic tumor.

            A broad spectrum of complications can occur after radiofrequency (RF) ablation of hepatic tumors, even though it has been accepted as a safe and effective technique for unresectable hepatic tumors. Recently, the rare complication of brochobiliary fistula was encountered after RF ablation in a patient with a metastatic tumor from stomach cancer. It was assumed to have developed from collateral damage to the adjacent diaphragm and lung base as well as biloma formation at the ablation zone. Symptomatic improvement was achieved by conservative management with an external drainage catheter, but the fistula was still persistent on a 2-month follow-up image.
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              Liver abscess of hydatid origin: clinical features and results of aggressive treatment.

              Cyst infection and subsequent liver abscess formation are complications of liver echinococcosis. Traditionally, this condition has been treated by simple drainage, a procedure associated with unsatisfactory postoperative evolution. The present paper examines a series of cases involving infected liver echinococcal cysts. Surgery was performed at the Temuco Regional Hospital after assessment was made of general and liver laboratory parameters, chest X-ray and abdominal ultrasound were performed and antibiotic treatment was administered. The procedure consisted of surgical drainage, parasite material extirpation and pericystic membrane resection with surrounding healthy liver parenchyma. The morbidity and mortality rate, hospital stay and evidence of recurrent hydatid disease were evaluated. Forty-nine patients (21 male and 28 female), with a median age of 45 years (range 16-84 years), with infected cysts measuring 14 cm in ultrasonographical diameter (range 5-30 cm) were operated on. In the majority of cases, liver abscesses were located in the right lobe (37 patients, 75.4%) and the most frequent computed tomography scan pattern was heterogeneous (40 patients, 81.6%). The median hospital stay was 5 days, the median follow-up period was 32 months (range 2-91 months) and perioperative morbidity was 24.4%. Surgical complications were verified in five patients (10.2%) and medical complications occurred in seven cases (14.3%). No recurrence of hydatid disease was observed. Mortality was 2% (one patient). Good results were obtained when hydatid liver abscesses were treated aggressively.

                Author and article information

                Revista chilena de cirugía
                Rev Chil Cir
                Sociedad de Cirujanos de Chile (Santiago, , Chile )
                June 2006
                : 58
                : 3
                : 224-227
                [02] orgnameHospital Hernán Henríquez Aravena orgdiv1Servicio de Cirugía y Urgencia Chile
                [01] orgnameUniversidad de La Frontera orgdiv1Departamento de Cirugía y Traumatología Chile
                [03] orgnameClínica Alemana de Temuco orgdiv1Servicio de Cirugía Chile
                S0718-40262006000300012 S0718-4026(06)05800300012

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                : 12 September 2005
                : 12 February 2006
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 4

                SciELO Chile

                CASOS CLÍNICOS

                Bronchobiliary fistula,hydatid cyst,quiste hidatídico pulmonar,Fístula bilibronquial,cystectomy


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