Subject(s)
Biliary Fistula , Lithotripsy , Pancreatic Fistula , Pancreatitis, Acute Necrotizing , Humans , Lithotripsy/adverse effects , Lithotripsy/methods , Pancreatitis, Acute Necrotizing/etiology , Pancreatitis, Acute Necrotizing/therapy , Pancreatitis, Acute Necrotizing/complications , Pancreatic Fistula/etiology , Pancreatic Fistula/therapy , Biliary Fistula/etiology , Biliary Fistula/therapy , Male , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Middle AgedABSTRACT
Cystic echinococcosis is a zoonotic parasitic disease that affects the liver in more than 70% of cases, and there is still an underestimated incidence in endemic areas. With a peculiar clinical presentation that ranges from paucisymptomatic illness to severe and possibly fatal complications, quality imaging and serological studies are required for diagnosis. The mainstay of treatment to date is surgery combined with antiparasitic agents. The surgical armamentarium consists of open and laparoscopic procedures for selected cases with growing confidence in parenchyma-sparing interventions. Endoscopic retrograde cholangiopancreatography (ERCP) is extremely useful for the diagnosis and treatment of biliary fistulas. Recent relevant studies in the literature are reviewed, and two complex cases are presented. The first patient underwent open surgery to treat 11 liver cysts, and during the follow-up, a right pulmonary cyst was diagnosed that was treated by minimally invasive surgery. The second case is represented by the peritoneal rupture of a giant liver cyst in a young woman who underwent laparoscopic surgery. Both patients developed biliary fistulas that were managed by ERCP. Both patients exhibited a non-specific clinical presentation and underwent several surgical procedures combined with antiparasitic agents, highlighting the necessity of customized treatment in order to decrease complications and successfully cure the disease.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Echinococcosis, Hepatic , Female , Humans , Biliary Fistula/diagnostic imaging , Biliary Fistula/etiology , Echinococcosis, Hepatic/diagnostic imaging , Echinococcosis, Hepatic/complications , Echinococcosis, Hepatic/surgery , Laparoscopy/methods , Liver/diagnostic imaging , Liver/pathology , Tomography, X-Ray Computed/methodsABSTRACT
Bronchobiliary fistulas are defined as an abnormal communication between the biliary system and the bronchial tree. They are extremely rare complications of radiofrequency or microwave ablation. A 39-year-old woman with a history of neuroendocrine pancreatic carcinoma suffering from liver metastasis was treated with microwave ablation (MWA). In this case report, we present a case of intractable biliptysis from a bronchobiliary fistula secondary to an MWA. The patient was diagnosed by endoscopic retrograde cholangiopancreatograph and hepatobiliary scintigraphy. Treatment involved a right hemihepatectomy, a redo-hepaticojejunostomy, and the surgical placement of a transhepatic drain. After 6 weeks of drain placement, this could be removed. The fistula was thus successfully treated.
Subject(s)
Biliary Fistula , Bronchial Fistula , Liver Neoplasms , Humans , Female , Biliary Fistula/etiology , Biliary Fistula/diagnostic imaging , Biliary Fistula/surgery , Bronchial Fistula/etiology , Bronchial Fistula/diagnostic imaging , Adult , Liver Neoplasms/secondary , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/surgery , Treatment Outcome , Microwaves/therapeutic use , Microwaves/adverse effects , Hepatectomy , Drainage , Pancreatic Neoplasms/secondary , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathologyABSTRACT
BACKGROUND: External biliary fistula, where the residual cyst is associated with the biliary tree, is one of the most common complications after liver hydatid cyst surgery. Surgical procedures become a consideration for patients in whom the biliary fistula persists despite all endoscopic procedures. However, reoperation for biliary fistula after hydatid cyst surgery leads to additional complications and increases morbidity and mortality. AIM: This study aims to treat persistent biliary fistulas that develop after liver hydatid cyst surgery using a simple noninvasive technique. MATERIALS AND METHODS: External drainage surgery was performed on 295 patients with liver hydatid cysts. Endoscopic treatment methods were used in patients who developed biliary fistula after surgery. Despite all endoscopic treatment methods, 14 patients developed persistent biliary fistulas. These patients were subsequently treated using the drain clamping technique. FINDINGS: All persistent fistulas occluded in 11.86 days (with a range of 8-20 days). No complications were observed in the one-year follow-up visits. CONCLUSION: Drain clamping, a novel approach to the treatment of persistent biliary fistulas developed despite all available endoscopic methods, can be safely used. This technique resulted in a complete recovery in patients without the need for surgical procedures.
Subject(s)
Biliary Fistula , Echinococcosis, Hepatic , Humans , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Constriction , Echinococcosis, Hepatic/surgery , Echinococcosis, Hepatic/complications , Drainage , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective StudiesSubject(s)
Biliary Fistula , Bronchial Fistula , Embolization, Therapeutic , Enbucrilate , Humans , Enbucrilate/therapeutic use , Cholangiopancreatography, Endoscopic Retrograde , Bronchial Fistula/etiology , Bronchial Fistula/therapy , Biliary Fistula/etiology , Biliary Fistula/therapy , FluoroscopySubject(s)
Biliary Fistula , Cutaneous Fistula , Thoracic Wall , Humans , Cutaneous Fistula/etiology , Thoracic Wall/injuries , Biliary Fistula/etiology , Biliary Fistula/surgery , Biliary Fistula/diagnostic imaging , Male , Gallbladder Diseases/complications , Gallbladder Diseases/etiology , Gallbladder Diseases/diagnostic imaging , Thoracic Injuries/complications , AdultABSTRACT
Cholecysto-cutaneous fistula (CCF) is a rare complication of untreated biliary pathology, with fewer than 100 cases documented in the literature. Most are secondary to bacterial infection, although it has also been described in gallbladder adenocarcinoma and post trauma. Its clinical presentation is variable, being able to present systemic affection, and its most frequent external drainage site is in the right hypochondrium. Due to the low incidence of this pathology, and the variety of forms of presentation, its management does not have, to date, standardized bases. We present two cases of patients who consulted in the emergency room at the Hospital Nacional de Clínicas for presenting cholecysto-cutaneous fistula. The treatment of both was surgical.
La fístula colecisto-cutáneas (FCC) es una rara complicación de la patología biliar no tratada, habiendo menos de 100 casos documentados en la literatura. La mayoría son secundarias a infección bacteriana, aunque también fue descripta en el adenocarcinoma de vesícula y posterior a traumatismo. Su presentación clínica es variable, pudiendo presentar afección sistémica, y su sitio más frecuente de drenaje externo es en hipocondrio derecho. Debido a la baja incidencia de esta afección, y a la variedad de formas de presentación, su manejo no tiene hasta el momento bases estandarizadas. Presentamos dos casos de pacientes que consultaron por guardia de urgencias en el Hospital Nacional de Clínicas por presentar fistula colecisto-cutánea. El tratamiento de ambos fue quirúrgico.
Subject(s)
Biliary Fistula , Cutaneous Fistula , Humans , Cutaneous Fistula/diagnostic imaging , Cutaneous Fistula/etiology , Cutaneous Fistula/surgery , Gallbladder , Biliary Fistula/diagnostic imaging , Biliary Fistula/etiology , Biliary Fistula/surgeryABSTRACT
RATIONALE: Percutaneous transhepatic biliary drainage (PTBD) plays a significant role especially in the diagnosis and decompression of bile duct obstruction. However, it is associated with complications such as hemobilia, occlusion of drainage, bile leakage, and even bronchobiliary fistula (BBF). PATIENT CONCERNS AND DIAGNOSES: We herein describe a patient with a complication of BBF caused by long-term indwelling PTBD catheters. She underwent multiple operations including bilioenteric anastomosis, hepatic left lateral lobectomy, and long-term PTBD treatment. Her symptoms were mainly cough, fever, and yellow sputum and her diagnosis was confirmed by sputum culture (bilirubin detection was positive). INTERVENTIONS AND OUTCOMES: The patient recovered uneventfully by minimally invasive treatment, was discharged after 1 week of hospitalization, and the drainage tube was removed 2 weeks later. During 2 years of follow-up, no recurrence of BBF was observed. LESSONS: Patients with long-term indwelling PTBD catheters for biliary tract obstruction may lead to BBF. The treatment plan of BBF is tailored to the patient's individualized characteristics. And minimally invasive treatments might be an effective alternate way for the treatment of BBF. The accurate diagnosis, precision treatment, and multidisciplinary team play important roles in the treatment of BBF.
Subject(s)
Biliary Fistula , Cholestasis , Humans , Female , Biliary Fistula/diagnosis , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholestasis/complications , Drainage/adverse effects , Catheters/adverse effects , Anastomosis, Surgical/adverse effectsABSTRACT
BACKGROUND: Endocystectomy is a conservative surgical approach to managing cystic echinococcosis. Bile leakage is the main complication of this technique. The aim of this study was to evaluate the factors associated with bile leakage and to assess the outcomes and cost efficiency of strategies used to treat bile leakage. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent endocystectomy between 2005 and 2020 were included. The preoperative characteristics, intra- and postoperative outcomes, hospital costs, and cost efficiency (the Diagnosis-Related Group reimbursement minus the overall cost) were evaluated prospectively. A total of eighty patients with 142 cysts were included. Postoperative complications occurred in 17 patients (21%), including 11 patients with bile leakage (type A: 1, type B: 6 and type C: 4 patients, total 13%). Bile leakage was more frequent in patients with preoperative MRI signs of cysto-biliary fistulas or intraoperative visible cysto-biliary fistulas (p = 0.03 and p = 0.04, respectively) and in patients with cysts larger than 8 cm (p = 0.03). Patients with bile leakage who underwent reoperation (type C) had significantly shorter hospital stays (9 vs. 16 days, p<0.01) and better cost efficiency than those who received radiologic or endocscopic interventions (2,072 vs. -2,097 p = 0.01). No mortality was observed, and recurrence was seen in two patients. CONCLUSIONS/SIGNIFICANCE: Endocystectomy is a safe and efficient technique. Preoperative and intraoperative cysto-biliary fistulas and a cyst diameter larger than 8 cm are correlated to postoperative bile leakage. Early operative management of bile leakage reduces hospital stay and improves cost efficiency compared with radiologic or endoscopic treatments.
Subject(s)
Biliary Fistula , Cysts , Echinococcosis, Hepatic , Humans , Biliary Fistula/etiology , Biliary Fistula/surgery , Biliary Fistula/diagnosis , Echinococcosis, Hepatic/surgery , Echinococcosis, Hepatic/diagnosis , Risk Factors , Endoscopy , Retrospective StudiesABSTRACT
Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.
Subject(s)
Aneurysm , Biliary Fistula , Hemobilia , Jaundice, Obstructive , Humans , Biliary Fistula/diagnosis , Biliary Fistula/etiology , Biliary Fistula/surgery , Hemobilia/etiology , Hemobilia/complications , Aneurysm/surgery , Hepatic Artery/diagnostic imaging , Hepatic Artery/surgery , Jaundice, Obstructive/diagnosis , Jaundice, Obstructive/etiology , Jaundice, Obstructive/surgeryABSTRACT
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
Subject(s)
Biliary Fistula , Gallbladder Diseases , Gastric Fistula , Humans , Endosonography , Biliary Fistula/diagnostic imaging , Biliary Fistula/etiology , Biliary Fistula/surgery , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Gastric Fistula/diagnostic imaging , Gastric Fistula/etiologySubject(s)
Biliary Fistula , Bronchial Fistula , Enbucrilate , Humans , Enbucrilate/therapeutic use , Cholangiography , Biliary Fistula/diagnostic imaging , Biliary Fistula/etiology , Biliary Fistula/therapy , Endoscopy , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Bronchial Fistula/therapy , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
Thoracobiliary fistula (TBF) is a rare condition, in which an atypical communication between the bronchial tree and the biliary tree is present. A comprehensive literature search was conducted on Medline, Embase and Web of Science databases for studies reporting TBF in children. Data regarding patient demographics, site of fistula presentation, preoperative diagnostic procedures needed, and treatment modalities employed were extracted for further analysis. The study pool consisted of 43 studies incorporating 48 cases of TBF. The most frequent symptom was bilioptysis (67%), followed by dyspnea (62.5%), cough (37.5%) and respiratory failure (33%). Regarding the origin of fistula, the left hepatic duct was involved in 29 cases (60.4%), the right hepatic duct in 4 cases (8.3%), and the hepatic junction in 1 case (2%). Surgical management was employed in 46 patients (95.8%). Fistulectomy was performed in 40 patients (86.9%), lung lobectomy or pneumonectomy in 6 (13%), Roux en Y hepaticojejunostomy in 3 (6.5%), and decortication or drainage in 3 cases (6.5%). Three patients died (overall mortality 6.3%), while 17 patients suffered from postoperative complications (overall morbidity 35.4%). TBF in children is a rare but morbid entity which evolves as a result of congenital malformation in the majority of cases. Preoperative imaging of the biliothoracic communication and proper surgical treatment are the components of current management.
Subject(s)
Biliary Fistula , Biliary Tract Surgical Procedures , Humans , Child , Biliary Fistula/diagnosis , Biliary Fistula/etiology , Biliary Fistula/surgery , Liver , Hepatic Duct, Common , Biliary Tract Surgical Procedures/adverse effects , Drainage/adverse effectsABSTRACT
A 54-year-old man presented with signs of small bowel obstruction. CT showed the Riglers triad: pneumobilia, small bowel obstruction and an ectopic calcified gallstone. The ileus is caused by a gallstone which has perforated through a choleduodenal fistula.
Subject(s)
Biliary Fistula , Gallstones , Ileus , Intestinal Obstruction , Male , Humans , Middle Aged , Gallstones/complications , Ileus/etiology , Intestinal Obstruction/etiology , Biliary Fistula/etiology , Abdominal Pain/complicationsABSTRACT
Cholelithiasis complicated by cholecystoduodenal fistula and small bowel biliary obstruction is an absolute indication for surgical treatment. Modern possibilities of intraluminal endoscopy (electrohydraulic lithotripsy) made it possible to avoid intra-abdominal access (laparotomy, laparoscopy) and postoperative complications. Finally, rapid rehabilitation was noted.
Subject(s)
Biliary Fistula , Cholelithiasis , Cholestasis , Duodenal Obstruction , Intestinal Fistula , Lithotripsy , Humans , Duodenal Obstruction/diagnosis , Duodenal Obstruction/etiology , Duodenal Obstruction/surgery , Cholelithiasis/complications , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Endoscopy/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Lithotripsy/adverse effects , Intestinal Fistula/diagnosis , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Biliary Fistula/diagnosis , Biliary Fistula/etiology , Biliary Fistula/surgeryABSTRACT
BACKGROUND AND AIM: For those with a centrally located HCC, the two types of liver sectionectomy that can be performed are extended hepatectomy (EH) and central hepatectomy (CH). This meta-analysis aimed to compare the short- and long-term outcomes between patients treated with CH and patients treated with EH for those with centrally located HCC. METHOD: We searched PubMed, Scopus, Web of Science, and Cochrane library for eligible studies from inception to 1 April 2022 and a systematic review and meta-analysis were done to compare the outcomes between the two groups. RESULTS: we included 9 studies with a total of 1674 patients in this study. The pooled results in this meta-analysis showed equal long-term overall survival, Disease-free survival, recurrence and mortality between the two groups (5-year OS, RR = 1.14, 95% CI = 0.96-1.35, P = 0.12; I2 = 56%), (5-year DFS, RR = 0.81, 95% CI = 0.61-1.08, P = 0.15; I2 = 60%), (Recurrence, RR = 1.04, 95% CI = 0.94-1.15, P = 0.45; I2 = 27%), and (Mortality, RR = 0.55, 95% CI = 0.26-1.15, P = 0.11; I2 = 0%). In addition to that, no significant difference could be detected in the overall incidence of complications between the two groups (Complications, RR = 0.94, 95% CI = 0.76-1.16, P = 0.57; I2 = 0%). However, CH is associated with a remarkable increase in the rate of biliary fistula (Biliary fistula, RR = 1.90, 95% CI = 1.07-3.40, P = 0.03; I2 = 0%). And Liver cell failure was higher in the case of EH (LCF, RR = 0.47, 95% CI = 0.30-0.76, P = 0.002; I2 = 0%). Regarding the operative details, CH is associated with longer operative time (Time of the operation, Mean difference = 0.82, 95% CI = 0.36, 1.27, P = 0.0004; I2 = 57%). CONCLUSION: No significant difference in the short and long-term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decreases the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumour recurrence.