Fístula biliobronquial secundaria a quiste hidatídico hepático en tránsito torácico: caso clínico / Bronchobiliary fistula secondary to hepatic hydatid cyst in thoracic transit: clinical case

Resumen Introducción: En un quiste hidatídico hepático pueden ocurrir una serie de complicaciones de diversa gravedad. Una es el tránsito hepatotorácico (THT), que es el compromiso simultáneo de hígado, diafragma y pulmón secundario a migración de un quiste hidatídico hepático. Objetivo: Presentar una complicación de baja incidencia de un quiste hidatídico hepático como lo es el THT con fistula biliobronquial y posterior resolución quirúrgica. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Paciente con diagnóstico de quiste hidatídico en tránsito hepatotorácico con fístula biliobronquial fue sometida a toracotomía, resección en cuña del pulmón incluyendo bronquios comunicantes con el quiste. Paciente presenta evolución clínica e imagenológica favorable. Discusión: Se discuten formas de presentación, complicaciones de la evolución, grados de progresión y ubicaciones anatómicas frecuentes. Se hace énfasis en rol de la clínica e imagenología para diagnóstico y lo controversial del manejo. Conclusión: Tratamiento quirúrgico dependerá de localización de la lesión, estado del quiste, tamaño y experiencia del equipo quirúrgico, siendo una quistectomía con tratamiento de los trayectos fistulosos una buena alternativa.

Introduction: A variety of severe complications can occur in a hepatic hydatid cyst. One of them is the transit from liver to thorax through the diaphragm (HTT). Aim: To present a low impact complication of a hepatic hydatid cyst such as HTT with bronchobiliary fistula and subsequent surgical procedure. Materials and Method: Clinical, imaging, and photographic record of the clinical event. Results: A patient with a diagnosis of hydatid cyst in hepatothoracic transit with bronchobiliary fistula underwent thoracotomy with a wedge resection of the lung, including a cyst-bronchial communication. The patient presents good clinical and imaging evolution. Discussion: Forms of presentation, evolutionary complications, stages of progression, and frequent anatomical locations are discussed. Emphasis is made on the role of the clinical examination and imaging tests for diagnosis and controversial management. Conclusión: Surgical treatment will depend on location of the lesion, experience of the surgical team, condition and size of the cyst, being a cystectomy with the treatment of the fistulous tracts a good alternative.

Communicating Bronchopulmonary Foregut Malformation Type III with Pulmonary Sequestration Diagnosed in a Newborn: A Case Report

Communicating bronchopulmonary foregut malformation (CBPFM) is a communication between the respiratory and gastrointestinal tracts that can be difficult to differentiate from pulmonary sequestration or H-type tracheoesophageal fistula (TEF) because of the similarities in clinical features. A female neonate born at full term had been experiencing respiratory difficulty during feeding from the third day of life. The esophagography performed to rule out H-type TEF revealed that the esophageal bronchus directly communicated with the left lower lobe (LLL) of the lung. Lobectomy of the LLL, fistulectomy of the esophagobronchial fistula, and primary repair of the esophagus were performed. Finally, CBPFM type III with pulmonary sequestration was confirmed on the basis of the postoperative histopathological finding. We report the first newborn case of CBPFM type III with pulmonary sequestration in Korea.

Fistula bronco-pericárdica en una mujer joven por actinomicosis pulmonar complicada / Broncho-pericardial fistula in one young woman by actinomicosis complicated pulmonary

Mujer de 26 años de edad que ingresa al servicio de urgencias deshidratada, en malas condiciones generales, con cuadro de diarrea de alto gasto asociada con dolor abdominal. Refiere antecedentes de asma en tratamiento con corticoterapia, neumonía bacteriana hace seis meses para la que recibió tratamiento por tres meses, con presencia de nódulo pulmonar sin etiología determinada. Durante la hospitalización presenta deterioro progresivo con signos de inflamación sistémica y fallece al tercer día de hospitalización. En el estudio macroscópico se observó el pericardio adherido al pulmón derecho, que al cortarlo hay salida de líquido purulento, aproximadamente 500 . En el lóbulo medio del pulmón derecho se reconoce absceso pulmonar y fistula que comunica al pericardio.

Omentum Transplantation in Thorax to Cover Bronchial Stump as Treatment of Bronchopleural Fistula After Pulmonary Resection: Report of 6 Cases' Experience / 中国肺癌杂志

BACKGROUND@#Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method.@*METHODS@#During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points.@*RESULTS@#The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients' bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months.@*CONCLUSIONS@#Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation.

Fístula biliopleurobronquial: reporte de un caso / Bronchobiliary fistula: Report of a case

La fístula biliopleurobronquial (FBB) es una comunicación anormal entre la vía biliar y el árbol bronquial. Es una condición infrecuente, generalmente secundaria a un proceso infeccioso local o a un evento traumático. La bilioptisis es patognomónica. Presentamos el caso de una mujer de 37 años con historia de cirrosis biliar secundaria, en lista para trasplante hepático, con múltiples episodios de colangitis previos y usuaria de derivación biliar externa, quien curso con bilioptisis y mediante gammagrafía HIDA con SPECT se confirmó fistula biliopleurobronquial. Éste caso se resolvió con derivación percutánea de la vía biliar

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract

Fístula colobrônquica por adenocarcinoma de cólon: relato de caso / Colobronchial fistula due to colon adenocarcinoma: case report

Fístula colobrônquica é uma complicação rara de doença do trato gastrintestinal. Geralmente manifesta com sintomatologia respiratória inespecífica, o que dificulta o diagnóstico. Pode ser a primeira manifestação da doença abdominal, refletindo quadro avançado e, portanto, de difícil abordagem. Relatamos o caso de uma paciente do sexo feminino, 72 anos, que apresentou fístula colobrônquica por adenocarcinoma de cólon no ângulo esplênico, manifestada por tosse crônica.(AU)

The colobronchial fistula is a rare complication of gastrointestinal tract disease. It is usually manifested with nonspecific respiratory symptomatology, which makes diagnosis difficult. It may be the first manifestation of abdominal disease, reflecting advanced disease and therefore being difficult to approach. We report a case of a female patient, 72 years old, who presented with colobronchial fistula due to colon adenocarcinoma in the splenic angle, manifested by chronic cough.(AU)

Abordaje toraco-abdominal de la fístula broncobiliar / Thoraco-abdominal approach in bronchobiliary fistula

La fístula broncobiliar es una entidad poco usual en nuestro medio y poco descrita en la literatura científica. Se caracteriza por una comunicación anómala entre el árbol bronquial y la vía biliar, y se asocia a la presencia de bilis en el esputo (bilioptisis). Según su etiología, puede ser secundaria a la obstrucción distal de la vía biliar por patología benigna, maligna, infecciosa o iatrogénica. Se presenta el caso de un paciente de 33 años, que cursó con una fístula broncobiliar secundaria a la derivación de la vía biliar percutánea por una lesión estenótica del confluente biliar, en quien ­por medio de un abordaje torácico y abdominal­ se practicó una lobectomía inferior por videotoracoscopia (Video-Assisted Thoracoscopy Surgery, VATS) y hepatectomía con reconstrucción de la vía biliar por laparotomía. Teniendo en cuenta lo inusual del caso, con pocos reportes en la literatura, se concluye la dificultad para establecer la posible etiología de las estenosis de la vía biliar en un paciente joven, sin poderse descartar la enfermedad maligna. Al hacer el diagnóstico, se debe tratar y corregir la causa; la cirugía sigue siendo el pilar del tratamiento y, con el advenimiento de la cirugía mínimamente invasiva, se puede hacer un manejo combinado para aprovechar los beneficios de la técnica, como se hizo en este caso

Bronchobiliary fistula is a rare entity in our environment and it is poorly described in the scientific literature. It is characterized by an abnormal communication between the bronchial tree and the biliary tract, and is associated with the presence of bile in the sputum (bilioptysis). According to its etiology, it may be secondary to a distal obstruction of the bile duct due to a benign, malignant, infectious, or iatrogenic pathology. We present the case of a 33-year-old patient who had a bronchobiliary fistula secondary to a percutaneous biliary tract bypass due to a stenotic lesion of the biliary confluent in whom an inferior lobectomy by video-assisted thoracoscopy surgery (VATS) was performed with hepatectomy with biliary tract reconstruction by laparotomy, a combined thoracic and abdominal approach. Given the low incidence of this type of cases and the scarce literature reports, our conclusion is that it is difficult to define the possible etiology of the bile duct stenosis in young patients, and that a malignant pathology cannot be ruled out. Once the diagnosis is established, the cause should be treated. Surgery remains the mainstay of treatment, and with the advent of minimally invasive surgery a combined type of management can be performed so as to take advantage of the benefits of this technology

Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage Due to Empyema / 대한구급학회지

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization / 대한소화기학회지

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage Due to Empyema / 대한중환자의학회지

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Fístula broncobiliar congénita: Caso dínico / Congenital broncho-biliary fistula: A case report

La fístula traqueo- o broncobiliar congénita o fístula hepatopulmonar congénita es una rara malformación con alta morbimortalidad si su diagnóstico no se realiza a tiempo. Existe una comunicación entre el sistema respiratorio (tráquea o bronquio) y el tracto biliar. Hasta la fecha, se han reportado solo 35 casos. Presentamos el caso de un neonato con neumopatía derecha y débito bilioso por el tubo endotraqueal. El diagnóstico se realizó mediante broncoscopía con radioscopía y la resección de la fístula broncobiliar fue por videotorascopía. Posteriormente, se requirió de una hepatectomía izquierda con anastomosis biliodigestiva en Y de Roux por presentar hipoplasia de colédoco.

Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula

Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.

Adjustable inspiratory occlusion valve in experimental bronchopleural fistula. A new therapeutic perspective

PURPOSE: To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation.METHODS:We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve.RESULTS:When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage.CONCLUSION: The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.

Fístula aortobronquial como causa de hemoptisis. Tratamiento endovascular. reporte de 2 casos / Fistula aortobronchial as a cause of hemoptysis. Endovascular treatment. report of 2 cases

La fístula aortobronquial (FAB) es una comunicación patológica entre la aorta torácica y el árbol bronquial, habitualmente del hemitórax izquierdo. Se trata de un cuadro muy poco frecuente en la actualidad, aunque letal si no se realiza un diagnóstico certero de forma temprana. El principal síntoma es la hemoptisis intermitente que a su vez puede ser leve, moderada y en ocasiones masiva. Debe sospecharse en pacientes con antecedente de cirugía cardíaca o de la aorta torácica, traumatismo de tórax o aneurisma aterosclerótico o infecciosos de la aorta torácica, rara vez una úlcera penetrante. El objetivo es reportar 2 casos de FAB en un Servicio de Cirugía Vascular, uno de ellos posterior a cirugía de corrección de coartación de aorta torácica descendente luego de 12 años, otro a causa de una úlcera aórtica penetrante en aorta torácica descendente, en ambos casos la hemoptisis fue el síntoma principal, y el tratamiento se realizó de forma exitosa por vía endovascular.

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

PURPOSE: To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS : Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS: Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION: Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure. .

Abordaje transesternal transpericárdico para cierre de fístula del muñón bronquial post neumonectomía / Trans-sternal, trans-pericardial approach for closure of post-pneumonectomy bronchial stump de hiscence

La fistula del muñón bronquial es una seria complicación de la neumonectomía, por su complejidad tanto en los cambios anatomofisiológicos que el paciente experimenta, como en la diversidad de recursos para su resolución. El objetivo de este estudio es la presentación de este primer caso en la historia quirúrgica del país de abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial post neumonectomía en el Hospital San Vicente en Guatemala. Método: Se presenta el caso de una paciente de sexo femenino a quien se le realizó neumonectomía derecha por tuberculosis pulmonar y que presentó dehiscencia del muñón bronquial por lo que se procedió a realizar abordaje transesternal transpericárdico para el cierre del muñón bronquial a nivel de la Carina. Resultados: Se da seguimiento a la paciente por 8 años tras los cuales el problema se considera resuelto. Conclusión: la utilización del abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial postneumonectomía permite alcanzar el bronquio en un ambiente no contaminado debiendo considerarse como un procedimiento adecuado para resolver este tipo de complicación.

Background: Bronchial stump fstula is a serious complicaton of pneumonectomy. The aim of this case report is to document the frst surgical patenttreated with trans-sternal, trans-pericardial approach for bronchial stump fstula closing afer pneumonectomy at San Vicente Hospital in Guatemala.Methods: A female patent who underwent right pneumonectomy for pulmonary tuberculosis with postoperatve bronchial stump dehiscence.Trans-sternal trans-pericardial approach was performed for closing the bronchial stump fstula at the carina.Results: Afer 8 years of follow up, the problem in the patent had completely resolved.Conclusion: Trans-pericardial trans-sternal approach for bronchial stump fstula closing allows bronchium access in a non-contaminated space andshould be considered to resolve this kind of complicaton.

Operative procedure choice for surgical management of chronic tuberculous empyema: a series of 461 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the experiences and operative procedure choice for surgical management of chronic tuberculous empyema.</p><p><b>METHODS</b>Totally 461 patients of chronic tuberculous empyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December 2011. There were 317 male and 144 female patients, aging from 6 to 79 years with a mean age of 32 years. Preoperative duration lasted from 3 months to 50 years, including 347 cases within 1 year, 61 cases 1 to 2 years, and 53 cases above 2 years. Chest tube drainage or pleuracentesis was performed in 395 patients, decortication in 287 patients, thoracoplasty in 13 patients, pleuropneumonectomy and resection of remaining lung in 11 patients, complex operation in 150 patients.</p><p><b>RESULTS</b>There was no death perioperatively. Four hundred and forty-five patients were cured at once, 6 patients were cured by stages. One patient with empyema and bronchial fistula relapsed bronchial fistula after pulmonary lobectomy and pleural decortication, whom was cured by the combination operation which including fistula repair, muscle flap tamponing and local thoracoplasty according to the closed drainage of thoracic cavity after 6 months. Three cases were suffered incision delayed healing and were cured by dressing change. Five cases were suffered abscess of chest wall within 3 months and were cured by local thoracoplasty. One patient died due to respiratory failure in one year which resulted in tuberculosis spreading because of bronchial fistula after pleuropneumonectomy.</p><p><b>CONCLUSIONS</b>Surgical management of chronic tuberculous empyema still have irreplaceable roles. Selecting appropriate operations according to different cases will achieve good results.</p>

Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.

Fístula aortobronquial como causa de hemoptisis masiva / Aortobronchial fistula as a cause of massive hemoptysis

INTRODUCCIÓN: Las fístulas aortobronquiales son una causa muy infrecuente de hemoptisis masiva. Se asocia a la presencia de un aneurisma aórtico, y su evolución es siempre letal sin un tratamiento oportuno. El objetivo es presentar un caso de fístula aortobronquial y la revisión de bibliografía respectiva. Presentación del caso: Paciente de género femenino, de 76 años, hipertensa y diabética, sin otros antecedentes mórbidos. Ingresó al Servicio de Urgencia por hemoptisis posterior a caída a nivel. La radiografía de tórax mostró imagen hiperdensa en vértice pulmonar izquierdo, asociada a desviación mediastínica contralateral. Evolucionó con episodio de hemoptisis masiva el cual fue tratado satisfactoriamente con reposición de volumen y transfusión de hemoderivados. La tomografía computada de tórax con contraste mostró aneurisma de aorta torácica, de diámetro máximo de 10,8 cm...

INTRODUCTION: Aortobronchial fistula is a very rare cause of massive hemoptysis. It is associated with the presence of an aortic aneurysm and its evolution is always fatal without prompt treatment. The objective is to present a case of aortobronchial fistula and to review the respective literature. Case Report: A 76 years old woman, hypertensive and diabetic, no other known morbid history. She was admitted to emergency room with mild hemoptysis after a fall. Chest X-ray showed hyperdense image in the left lung apex, associated with contralateral mediastinal shift. She was treated with antibiotics and antitussives. She evolved with an episode of massive hemoptysis which was successfully treated with fluid resuscitation and blood transfusion. Chest computed tomography showed large thoracic aortic aneurysm with a maximum diameter of 10.8 cm…