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      Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

      case-report

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          Abstract

          Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA), in which there is abnormal communications between the biliary tract and the bronchial trees. Surgery should only be considered for BBF when non-invasive interventions have failed. In this report, we describe the surgical management for BBF when complicated by an abscess that was encountered after RFA in a 52-year-old woman with recurrent hepatocellular carcinoma (HCC). She had previously undergone central bisectionectomy of HCC 7 years ago, and had been treated with a sixth transarterial chemoembolization and first RFA for recurrent HCC after the operation. After the liver abscess and BBF occurred in the posterior section of the liver, she received posterior sectionectomy and hepaticojejunostomy, drainage of the lung abscess, diaphragmatic resection and repair because it was impossible to drain the abscess radiologically. Symptomatic improvements were being achieved through operative treatments where pleural effusion and pneumonic consolidation was obliterated on a 2-months follow-up image.

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          Most cited references10

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

          To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF). Literature searches were performed in Medline, EMBASE, PHMC and LWW (January 1980-August 2010) using the following keywords: biliobronchial fistula, bronchobiliary fistula, broncho-biliary fistula, biliary-bronchial fistula, tracheobiliary fistula, hepatobronchial fistula, bronchopleural fistula, and biliptysis. Further articles were identified through cross-referencing. Sixty-eight cases were collected and reviewed. BBF secondary to tumors (32.3%, 22/68), including primary tumors (19.1%, 13/68) and hepatic metastases (13.2%, 9/68), shared the largest proportion of all cases. Biliptysis was found in all patients, and other symptoms were respiratory symptoms, such as irritating cough, fever (36/68) and jaundice (20/68). Half of the patients were treated by less-invasive methods such as endoscopic retrograde biliary drainage. Invasive approaches like surgery were used less frequently (41.7%, 28/67). The outcome was good at the end of the follow-up period in 28 cases (range, 2 wk to 72 mo), and the recovery rate was 87.7% (57/65). The clinical diagnosis of BBF can be established by sputum analysis. Careful assessment of this condition is needed before therapeutic procedure. Invasive approaches should be considered only when non-invasive methods failed.
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            Bronchobiliary fistula: principles of management.

            Bronchobiliary fistula is an uncommon entity. Recently, we encountered 2 patients with this problem. Both were treated successfully with resection of the involved pulmonary tissue and interposition of viable tissue between the lung and the fistulous tract. This approach, although invasive, provided a rapid resolution of the patients' problem.
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              Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

              Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.
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                Author and article information

                Journal
                Korean J Hepatobiliary Pancreat Surg
                Korean J Hepatobiliary Pancreat Surg
                KJHBPS
                Korean Journal of Hepato-Biliary-Pancreatic Surgery
                Korean Association of Hepato-Biliary-Pancreatic Surgery
                1738-6349
                2288-9213
                August 2013
                31 August 2013
                : 17
                : 3
                : 135-138
                Affiliations
                Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Dong Wook Choi. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3462, Fax: +82-2-3410-6980, dwchoi@ 123456skku.edu
                Article
                10.14701/kjhbps.2013.17.3.135
                4304527
                26155228
                fc8c1bbd-f1cf-4399-ade2-e4d9fb1e1707
                Copyright © 2013 by The Korean Association of Hepato-Biliary-Pancreatic Surgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 August 2013
                : 12 August 2013
                : 15 August 2013
                Categories
                Case Report

                bronchobiliary fistula,radiofrequency catheter ablation,hepatocellular carcinoma,hepatectomy

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