Cutaneous bronchobiliary fistula treated with Tissucol sealant.
Bronchobiliary fistula is a rare and is an uncommon but severe complication of hydatid disease of the liver. Treatment has traditionally been surgical resection, but embolization and stent placement have been described. The invasive method seems to be a key component of patient treatment. We describe a case of a 58-year-old woman who, 25 years before, had undergone surgery for a hydatid cyst. A total cystectomy without previous puncture or parasite extraction was carried out. The lower aspect of the cyst was found to be completely perforated over the biliary duct. During the postoperative course, the patient had subphrenic right-sided pleural effusion and biliary fistula that subsided with medical treatment. Afterward, the patient came to the outpatient area of our hospital complaining of leakage of purulent exudate through the cutaneous opening, pain located on the right hypochondrium radiating to the right hemithorax, malaise, fever, chronic cough, and occasional vomiting of bile. Fistulography revealed an anfractuous cavity communicating with a residual cystic cavity on the right hepatic lobe. We observed communication with the intrahepatic canaliculi. Computed tomographic scan revealed a fistulous tract on the anterior liver border through the abdominal wall. There were no posttreatment complications. The patient is asymptomatic.
Department of General and Digestive Surgery, La Paz Teaching Hospital, Rufino Blanco 17, Portal 5, Bajo A, Madrid 28028, Spain. iprieto@intermic.com
M I
MI
Prieto-Nieto
J P
JP
Pérez-Robledo
A
A
Alvarez-Luque
J I Acitores
JI
Suz
J Novo
JN
Torres
D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D057785:Catheters; D003287:Contrast Media / Q000008:administration & dosage; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D004444:Echinococcosis, Hepatic / Q000601:surgery; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014014:Tissue Adhesives; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives