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Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child.

Kumar P, Mehta P, Ismail J, Agarwala S, Jana M, Lodha R, Kabra SK - Lung India (2015 Sep-Oct)

Bottom Line: An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified.Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract.On follow-up child was asymptomatic and doing well.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

No MeSH data available.


Related in: MedlinePlus

(a) HIDA scan reveals reflux of the tracer agent through an abnormal communication in right bronchus (b) Abnormal tracer agent also accumulated in the right lower lobe of lung with patent bilio-enteric pathway
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Figure 2: (a) HIDA scan reveals reflux of the tracer agent through an abnormal communication in right bronchus (b) Abnormal tracer agent also accumulated in the right lower lobe of lung with patent bilio-enteric pathway

Mentions: Bronchoscopy revealed yellowish frothy secretion coming out of right main bronchus. A possibility of bronchobiliary fistula was kept, and broncho-alveolar lavage (BAL) fluid was sent for relevant investigations. BAL fluid revealed bilirubin of 2.5 mg/dL with conjugated fraction of 2 mg/dL. CECT chest and abdomen revealed trans-diaphragmatic bronchobiliary fistula with resolving abscess in right lobe of liver and consolidation of right lower lobe of lung [Figure 1b and c]. Magnetic resonance cholangiopancreatography (MRCP) revealed abnormal tract communicating between a tributary of right branch of the hepatic duct and a branch of right lower lobe bronchus [Figure 1d]. HIDA scan revealed good hepatocyte function, bronchobiliary fistula with extension of tracer in to right bronchus, trachea and abnormal tracer accumulation in right lower lobe of lung with patent bilio-enteric pathway [Figure 2]. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract under general anesthesia. Chest drain was removed on post-operative day 5. Child remained asymptomatic and was discharged on post-op day 10. On follow up after 3 months, she remained asymptomatic with no respiratory distress and was gaining weight.


Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child.

Kumar P, Mehta P, Ismail J, Agarwala S, Jana M, Lodha R, Kabra SK - Lung India (2015 Sep-Oct)

(a) HIDA scan reveals reflux of the tracer agent through an abnormal communication in right bronchus (b) Abnormal tracer agent also accumulated in the right lower lobe of lung with patent bilio-enteric pathway
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587006&req=5

Figure 2: (a) HIDA scan reveals reflux of the tracer agent through an abnormal communication in right bronchus (b) Abnormal tracer agent also accumulated in the right lower lobe of lung with patent bilio-enteric pathway
Mentions: Bronchoscopy revealed yellowish frothy secretion coming out of right main bronchus. A possibility of bronchobiliary fistula was kept, and broncho-alveolar lavage (BAL) fluid was sent for relevant investigations. BAL fluid revealed bilirubin of 2.5 mg/dL with conjugated fraction of 2 mg/dL. CECT chest and abdomen revealed trans-diaphragmatic bronchobiliary fistula with resolving abscess in right lobe of liver and consolidation of right lower lobe of lung [Figure 1b and c]. Magnetic resonance cholangiopancreatography (MRCP) revealed abnormal tract communicating between a tributary of right branch of the hepatic duct and a branch of right lower lobe bronchus [Figure 1d]. HIDA scan revealed good hepatocyte function, bronchobiliary fistula with extension of tracer in to right bronchus, trachea and abnormal tracer accumulation in right lower lobe of lung with patent bilio-enteric pathway [Figure 2]. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract under general anesthesia. Chest drain was removed on post-operative day 5. Child remained asymptomatic and was discharged on post-op day 10. On follow up after 3 months, she remained asymptomatic with no respiratory distress and was gaining weight.

Bottom Line: An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified.Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract.On follow-up child was asymptomatic and doing well.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

No MeSH data available.


Related in: MedlinePlus