ABSTRACT
Fístula bronquiobiliar (FBB) é uma afecção rara, de alta morbidade e mortalidade, decorrente da comunicação anormal entre a árvore brônquica e a via biliar, sendo a bilioptise um sinal clínico patognomônico. Normalmente está associada a doenças hepatobiliares, mas principalmente ao trauma e complicações de cirurgias hepatobiliares. Devido à gravidade e à complexidade, associadas à baixa incidência, seu manejo é desafiador, não havendo um consenso na literatura. Este trabalho identifica os métodos diagnósticos e terapêuticos mais utilizados, e propõe um fluxograma do manejo da FBB com intuito de auxiliar a conduta de novos casos.
Bronchobiliary fistula is a rare clinical finding, with a high morbidity and mortality rate, characterized by abnormal communication between the biliary tract and the bronchial tree, having bilioptysis as a pathognomonic sign. It is usually associated to hepatobiliary diseases, but mostly related to trauma and as a complication of hepatobiliary surgery. Due to the low incidence, complexity and gravity, its management is a challenge, and little consensus on its diagnosis and treatment exists. We identified the most used diagnostic and therapeutic procedures, and propose a flowchart that could assist in the management of news cases.
Subject(s)
Humans , Biliary Fistula/diagnostic imaging , Bronchial Fistula/diagnostic imaging , Biliary Fistula/surgery , Biliary Fistula/therapy , Bronchial Fistula/surgery , Bronchial Fistula/therapy , Abdominal Abscess , Echinococcosis , Liver Abscess , Lung AbscessABSTRACT
Bronchobiliary fistula is a rare disorder consisting of an abnormal communication between the bronchial tree and the biliary duct. In Western countries, trauma, postoperative biliary stenosis, and biliary lithiasis are the predominant causative factors of bronchobiliary fistula. Bilioptysis (bile stained sputum) is a pathognomic finding for bronchobiliary fistula. To date, there are just a few reported cases of bronchobiliary fistula after sclerosis of a liver cyst. We describe the case of a 74-year-old woman who developed bronchobiliary fistula after sclerosing therapy of a liver cyst. The diagnosis was confirmed by the presence of bilioptysis and the chest and dynamic liver CT findings. The patient was successfully treated with antibiotics and percutaneous transhepatic catheter drainage.