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 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.

Anesthetic management of congenital broncho-esophageal fistula in an adult.

Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.

Colobronchial fistula: A rare cause of chronic cough.

We report a colobronchial fistula in a middle-aged woman. She had been having cough with expectoration of sputum with a faeculent odour since the age of 7 years. Imaging revealed a fistulous connection between the hepatic flexure and the right bronchial tree, which was successfully repaired surgically.

Bronchoscopic management of bronchopleural fistula.

In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.

Diagnosis and management bronchopleural fistula.

The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.

Confident Diagnosis of Bronchobiliary Fistula Using Contrast-Enhanced Magnetic Resonance Cholangiography

We report the utility of contrast-enhanced magnetic resonance cholangiography (MRC) using gadoxetic acid (Gd-EOB-DTPA) in the diagnosis of bronchobiliary fistula associated with liver hydatid cyst. Contrast-enhanced MRC clearly delineated the leakage of contrast agent from the biliary duct and its communication with the bronchial tree. Providing functional information about physiologic or pathologic biliary flow in addition to the display of biliary anatomy, contrast-enhanced MRC stands as a robust technique in confidently detecting bronchobiliary fistula and bile leaks.

Gastropleural fistula following a splenectomy for splenic abscess: a case report.

Gastropleural fistula is a rare condition that occurs as a consequence of various thoraco-abdominal surgical procedures and septic conditions. The diagnosis is difficult, it needs a high index of suspicion and appropriate investigations. There are no previous reports of a patient developing a fistula after a splenectomy procedure. The authors report a twelve-year old boy who developed gastropleural fistula following thoracoabdominal surgery, a splenectomy. The patient presented with the clinical condition of chronic empyema thoracis and responded well to medical and surgical treatment.

Litiasis pulmonar secundaria a fístula colecistopleural / Secondary pulmonary lithiasis following cholecystopleural fistual

La litiasis pulmonar secundaria a fístula colecistopleural es una entidad infrecuente en la evolución de la colelitiasis que genera un potencial riesgo de vida para el paciente. Solo se ha publicado un caso en la bibiliografía angloparlante donde fue necesria una resección pulmonar para su tratamiento

Fístula broncopleural cutânea causada por Eikenella corrodens / Bronchopleural cutaneous fistula due to Eikenella corrodens

OBJETIVO: Fazer uma revisão sobre fistula cutânea broncopleural causada por Eikenella corrodens e relatar e discutir o caso de uma paciente. DESCRIÇAO: Paciente do sexo feminino, 16 anos de idade, foi encaminhada ao nosso hospital em estado febril com histórico de escarro com estrias de sangue há 2 meses; apresentava seqüelas neurológicas de encefalite herpética e estava confinada ao leito desde os cinco anos de idade. A mãe relatou ter detectado, dias antes, uma massa mole paraespinhal longitudinal. A paciente recebia alimentação via oral apesar da ocorrência de freqüentes engasgamentos nos últimos anos. A apalpação, a massa podia ser pressionada até encontrar menor resistência do espaço subcutâneo, estendendo-se longitudinalmente até a região torácica inferior. A tomografia torácica revelou pneumonia necrotizante do lobo direito inferior e uma fistula bronco pleural formando áreas de cavitação subcutânea. A paciente foi submetida a tratamento prolongado com antibióticos com decrescentes coletas de ar por 8 semanas. COMENTARIOS: A Eikenella corrodens tem sido indicada como potencial patógeno causador de infecções pleuropulmonares. Não há relatos de fístula pleurocutânea e formação de abscessos como complicadores de empiema e pneumonia necrotizante causados por infecção de E. corrodens. A presença de lesão torácica proeminente que aumenta e diminui com a respiração pode ser uma indicação de fistula pleurocutânea. O tratamento do empiema de Eikenella com antibióticos sem decorticação cirúrgica exige um tratamento prolongado com antibioticoterapia.

[Uncommun etiology of hemoptysis: aorto-bronchial fistula from tuberculous origin]

Aorto-bronchial fistula is a rare etiology of hemoptysis. We related an observation of aorto-bronchial fistula from a tuberculous origin in a 40 years old man. The patient was treated for tuberculous miliary during four months and was admitted for hemoptysis. A chest radiograph showed a posterior madiastinal mass. Computed tomography of the chest and aortography made the diagnosis of an important thrombosed aneurism of the thoracic aorta Tuberculosis origin was suspected with history of miliary, the vertebral lesions, the paravertebral fuseau and was confirmed by histology

Mioplastia en el tratamiento de fistulas broncopleurales / Myoplasty in the treatment of bronchopleural fistulas

Las fístulas broncopleurales posoperatorias asociadas o no a empiema constituyen una fuente importante de morbimortalidad en pacientes que han sufrido resecciones pulmonares, principalmente cuando se tratan enfermedades malignas. El objetivo de este artículo es revisar los resultados obtenidos en el tratamiento de 6 pacientes tratados entre 1997 y 2003. La operación previa fue neumonectomía derecha en 5 pacientes y lobectomía superior derecha en uno. Las causas de la operación fueron traumatismo, tumores benignos y malignos y tuberculosis. En los 6 pacientes se utilizó mioplastia con el dorsal ancho para la obliteración de la cavidad pleural remanente. Las técnicas complementarias comprendieron el uso de colgajos pediculados de músculo intercostal (3 pacientes), mioplastia con el músculo pectoral mayor y toracoplastia parcial en un paciente cada una. La complicación más frecuente fue la fuga aérea mantenida por más de 10 días. Todos los pacientes mantenían el cierre bronquial al año de la operación(AU)

The postoperative bronchopleural fistulas associated or not with empyema are an important source of morbimortality in patients that have suffered from pulmonary resections, mainly when malignant diseases are treated. The purpose of this article is to review the results obtained in the treatment of six patients from 1997 to 2003. The previous operation was right pneumonectomy in five patients and upper right lobectomy in one. The causes of the operation were traumatism, benign and malignant tumors and tuberculosis. In the six patients, it was used myoplasty with the wide dorsal for the obliteration of the remaining pleural cavity. The complementary techniques comprised the use of pedicled flaps of intercostal muscle (3 patients), myoplasty with the pectoralis major and partial thoracoplasty in a patient, each one. The most frequent complication was the aerial leakage maintained for more than ten days. All the patients kept the bronchial closure a year after the operation(AU)

Fístula colecisto-pleuro-pulmonar asociada con agenesia del lóbulo derecho hepático / Cholecysto-pleuro-pulmonar fistula associated to hepatic right lobe agenesia

Se reseñan los hallazgos observados con distintos métodos de diagnóstico en una paciente que presentó una fístula colecisto-pleuro-pulmonar asociada a agenesia del lóbulo hepático derecho con vesícula retrohepática subfrénica litiásica y un litobiliar migrado a la base pulmonar durante el período activo de la fístula. La asociación de dichas entidades es sumamente infrecuente existiendo escasas publicaciones en la literatura mundial. Se revisan los métodos de diagnóstico utilizados, las variantes, los diagnósticos diferenciales y la bibliografía referida al respecto

Fístulas bronquiales postoperatorias tardías / Late postoperatories bronchopleural fistulae

Entre julio de 1990 y septiembre de 1996, sobre un total de 83 resecciones pulmonares mayores, tres pacientes, portadores de carcinoma escamoso a los que se les realizó una neumonectomía derecha y cierre del muñón con sutura mecánica presentaron fístula broncopleural que se manifestó a los 24, 38 y 125 días de la operación. Se trataron con antibioticoterapia, drenaje, resutura del orificio fistuloso y toracoplastia, lográndose en los tres casos la resolución de la patología

Trichomonas en un empiema pleural / Trichomonas in pleural empyema

Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy