Bronchobiliary fistula: a rare complication of hepatic endometriosis.
OBJECTIVE
To report the case and surgical therapy of a patient with bilioptysis after vaginal delivery, caused by bronchobiliary fistula. Histologic analysis revealed endometrial glands embedded in the decidual stroma neighboring the liver and the lung.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 39-year-old patient, 7 days after vaginal delivery, without endometrial history.


METHODS
Synchronous liver and lung resection of a bronchobiliary fistula by laparotomy and a transdiaphragmatic approach.


METHODS
For complicated brochobiliary fistula caused by endometriosis, radical surgical treatment is mandatory.


RESULTS
Histopathologic analyses confirmed the presence of clusters of endometrial glands embedded in the decidual stroma that were neighboring the liver, and perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives.


CONCLUSIONS
Hepatic and perihepatic endometriosis can cause a bronchobiliary fistula. Exacerbation of the symptoms can be triggered by high estrogen levels, physiologically dominating the last trimester. For such a rare case, surgery is mandatory.
Schuld
Jochen
J
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany.
Justinger
Christoph
C
Wagner
Mathias
M
Bohle
Rainer M
RM
Kollmar
Otto
O
Schilling
Martin K
MK
Richter
Sven
S
D000328:Adult; D001658:Biliary Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001983:Bronchial Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D049590:Postpartum Period