title: Combined liver-kidney transplantation complicated by intraoperative discovery of a bronchobiliary fistula.
abstract: Herein, we report the case of an intraoperative diagnosis of bronchobiliary fistula during combined liver-kidney transplantation because of polycystic disease. The diagnosis necessitated changes in surgical and anesthesiologic management and in the overall medical decision-making process. Emergent isolation of the affected lung was instituted to mitigate a large air leak and ensure adequate respiratory exchange, and to enable surgical repair. The kidney transplantation procedure was delayed for a few hours, enabling hemodynamic and respiratory stabilization in the intensive care unit before conditions were deemed adequate to proceed. The posttransplantation course was complicated but eventually successful, and the patient recovered both liver and kidney function. At a later evaluation, we realized that diagnosis of bronchobiliary fistula could have been made preoperatively had the chest radiograph been interpreted correctly and had the clinicians involved had a higher degree of suspicion for this complication of polycystic liver disease.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: E
authors.initials: E
authors.lastname: Stock
authors.forename: A
authors.initials: A
authors.lastname: Vannucci
authors.forename: M
authors.initials: M
authors.lastname: Doyle
authors.forename: G A
authors.initials: GA
authors.lastname: Patterson
authors.forename: W
authors.initials: W
authors.lastname: Chapman
authors.forename: I
authors.initials: I
authors.lastname: Kangrga
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000150:complications* / Q000601:surgery*; D015529:Choledochal Cyst / Q000473:pathology; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008100:Liver Abscess / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019152:Paracentesis / Q000009:adverse effects; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D013902:Radiography, Thoracic; D016896:Treatment Outcome