Colobronchial fistula: an unusual complication after peritonectomy and hyperthermic intra-peritoneal chemotherapy (HIPEC).
BACKGROUND
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an innovative approach to peritoneal carcinomatosis. Due to the complexity of the combined procedure, high rates of potentially life-threatening complications have been reported. This is the first report of colobronchial fistula following CRS and HIPEC.


METHODS
A 70-year-old woman underwent CRS and HIPEC for papillary well-differentiated peritoneal mesothelioma. During the postoperative course, recurrent pneumonia occurred and bacteria of intestinal origin were isolated from expectorated sputum. Water-soluble contrast studies revealed direct communication between the left colon flexure and the bronchial tree. After appropriate medical and supportive therapies, the patient underwent resection of the splenic flexure and immediate anastomosis with complete recovery.


CONCLUSIONS
Colobronchial fistula is a rare and potentially lethal complication of CRS and HIPEC. A suggestive clinical picture and contrast studies allow conclusive diagnosis to be made. Surgery is a safe and effective therapeutic option.
Department of Surgery, National Cancer Institute, Milan, Italy.
Barbara
B
Laterza
Dario
D
Baratti
Guido
G
Cozzi
Shigeki
S
Kusamura
Grazia Daniela
GD
Oliva
Cecilia
C
Gavazzi
Luca
L
Fumagalli
Alessandro
A
Sironi
Domenico
D
Sabia
Marcello
M
Deraco
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003106:Colon; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008654:Mesothelioma / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011859:Radiography; D016896:Treatment Outcome