Anesthesia management in neonatal congenital bronchobiliary fistula: case report and literature review.

BACKGROUND: There is very little published literature and none that discussed care in a neonate regarding anesthetic risk and management of neonate with congenital bronchobiliary fistula during thoracoscopy and thoracotomy. This article analyzes related risk factors and literature review from perioperative ventilation, circulation and other aspects of management. CASE PRESENTATION: A neonate diagnosed as congenital bronchobiliary fistula combined with severe chemical pneumonia, consolidation of the lungs, and infection was facing the risk of anaesthesia under thoracoscopy exploration surgery, who experiened more than 20 days diagnostic period before operation. Many risk factors have led to conversion from minimally invasive surgery to thoracotomy, including persistent hypoxemia, hypercapnia, difficult surgical exposure and extremly difficulty of intraoperative ventilation management. Anesthesia maintenance after conversion to open access remained problematic. Fortunately the patient showed no sign of any adverse CNS effects after 4 months of follow-up. CONCLUSIONS: The most prominent anesthesia challenges are hypoxemia, increased airway resistance, impaired ventilation, and the risk of metabolic acidosis. Close cooperation among the entire neonatal medical team is the key factors in successful management of this rare case.

Isolated Congenital Tracheobiliary Fistula.

BACKGROUND: Congenital tracheobiliary fistula is a rare developmental anomaly with a persistent communication between the biliary system and the trachea. CHARACTERISTICS: A 7-day-old baby with severe respiratory distress and aspiration pneumonia. OUTCOME: Tracheobilliary fistula identified on bronchoscopy. Open surgical excision of fistula was followed by improvement. MESSAGE: This condition should be considered in the differential diagnosis of intractable aspiration pneumonia.

Fístula broncobiliar congénita: Caso dínico / Congenital broncho-biliary fistula: A case report

La fístula traqueo- o broncobiliar congénita o fístula hepatopulmonar congénita es una rara malformación con alta morbimortalidad si su diagnóstico no se realiza a tiempo. Existe una comunicación entre el sistema respiratorio (tráquea o bronquio) y el tracto biliar. Hasta la fecha, se han reportado solo 35 casos. Presentamos el caso de un neonato con neumopatía derecha y débito bilioso por el tubo endotraqueal. El diagnóstico se realizó mediante broncoscopía con radioscopía y la resección de la fístula broncobiliar fue por videotorascopía. Posteriormente, se requirió de una hepatectomía izquierda con anastomosis biliodigestiva en Y de Roux por presentar hipoplasia de colédoco.

Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

[Congenital broncho-biliary fistula: a case report]. / Fístula broncobiliar congénita: caso dínico.

Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

La fístula traqueo- o broncobiliar congénita o fístula hepatopulmonar congénita es una rara malformación con alta morbimortalidad si su diagnóstico no se realiza a tiempo. Existe una comunicación entre el sistema respiratorio (tráquea o bronquio) y el tracto biliar. Hasta la fecha, se han reportado solo 35 casos. Presentamos el caso de un neonato con neumopatía derecha y débito bilioso por el tubo endotraqueal. El diagnóstico se realizó mediante broncoscopía con radioscopía y la resección de la fístula broncobiliar fue por videotorascopía. Posteriormente, se requirió de una hepatectomía izquierda con anastomosis biliodigestiva en Y de Roux por presentar hipoplasia de colédoco.

Minimally Invasive Surgical Repair for Congenital Bronchobiliary Fistula in an Adult.

Congenital bronchobiliary fistula (CBBF) is a very rare disease and usually requires surgical intervention at a young age. We report a case of CBBF in an adult who was treated successfully with a minimally invasive endoscopic operation.

Congenital tracheobiliary fistula in an adolescent patient.

Congenital tracheobiliary fistula is a rare malformation that allows communication between the respiratory system and hepatobiliary tract. We describe a male adolescent patient who was admitted with a destroyed lung caused by repetitive bile pneumonitis with a congenital tracheobiliary fistula. Left pneumonectomy was performed, and the fistula tract was successfully divided.

Congenital tracheobiliary fistula: a case report with review of literature.

Congenital tracheo-or-bronchobiliary fistula is a rare anomaly. Here, we present a malnourished child with persistent and recurrent respiratory symptoms. Flexible bronchoscopy and imaging studies were carried out to ascertain the diagnosis, anatomy and associated anomalies prior to surgery. Patient underwent successful corrective surgery with complete resolution of symptoms.

Congenital tracheobiliary fistula.

Congenital tracheobiliary fistula is a rare malformation that can present with a variety of respiratory symptoms. We present a case of a newborn patient with a tracheobiliary fistula and severe respiratory insufficiency needing extracorporal membrane oxygenation to recover.

[Congenital bronchobiliary fistula: a case report]. / Fistule bronchobiliaire congénitale : à propos d'une observation.

Congenital bronchobiliary fistulas (CBBF) are rare developmental anomalies. We report a case of a 6-day-old newborn who presented with respiratory distress and bilioptysis, originally involving a meconium aspiration syndrome. The diagnosis was confirmed by bronchoscopy. Surgery was performed at the age of 26 days and the newborn died the following day. Operative opacification showed communication between the carina and the biliary system. We review the clinical characteristics of CBBF and the value of early diagnosis and surgical treatment to prevent pulmonary complications due to bile salts.

Surgical experience in a baby with congenital broncho-biliary fistula.

Congenital tracheobiliary and bronchobiliary fistulae are rare malformations in which patent communications exist between the respiratory system and biliary tract, respectively. We present a newborn who was admitted with respiratory distress and bilious tracheal discharge. Investigation revealed a bronchobiliary fistula originating from the left main bronchus, as well as biliary atresia. Excision of the bronchobiliary fistula was successful and the connection between biliary tract and gastrointestinal system was established by performance of a Roux-en-Y cholecysto-jejunostomy. Diagnostic tools, differential diagnosis, and surgical correction strategies are discussed.

Congenital bronchobiliary fistula in a 65-year-old woman.

Congenital bronchobiliary fistula (CBBF) is quite a rare malformation and the diagnosis is usually made within a few hours or years from birth because of lower respiratory diseases beginning from early infancy. Surgical repair is necessary. Of the 29 cases reported, 4 occurred in adults aged 22-32 years. We detected CBBF incidentally in a 65-year-old woman. During bronchoscopy and thoracic computed tomographic study of the pulmonary nodules, we found an accessory bronchus descending from the carina and composed of a dark green secretion that contained 10% bilirubin. Drip infusion cholangiography revealed air in the left bile duct. Cholescintigraphy showed dilatation of the left bile duct and radiotracer pooling at the top edge of the left hepatic lobe. These findings indicated a narrow fistula between the airway and biliary duct. We attributed the patient's long survival without major complications to the narrowness of the communication. To our best knowledge, this is the fifth and oldest reported adult diagnosed with CBBF.

Congenital tracheobiliary fistula diagnosed with contrast-enhanced CT and 3-D reformation.

Congenital tracheobiliary fistula (CTBF) is a rare malformation. So far 24 cases have been reported in the English language literature. The imaging techniques used in diagnosis have been bronchography, fistulography, cholangiography, hepatobiliary nuclear imaging and MRI. We report a newborn patient who presented with right lung consolidation and biliptysis. The radiographic diagnosis of tracheobiliary fistula was made on multidetector CT scan of the chest and abdomen. Multiple 3-D volume-rendered reformations were performed. An abnormal air-filled tract was seen connecting the posteroinferior aspect of the carina and left biliary system, which was successfully treated surgically.

[Congenital bronchobiliary fistula detected by cholescintigraphy]. / Fistula broncobiliar congénita detectada por colescintigrafía.

A case of a six-year-old female patient diagnosed with congenital bronchobiliary fistula is presented. Only 20 cases have been reported in the literature of this disease in this institution. The patient showed signs and symptoms of a respiratory illness from birth that complicated progressively. She was submitted to multiple imaging studies like chest X rays, CT, ultrasound and Tc-99m HIDA cholescintigraphy. This procedure confirmed the presence of a bronchobiliary fistula that was corrected by surgery, with subsequent improvement of clinical symptoms.

Umbilico-biliary fistula in a dog.

This case report describes a previously unreported congenital malformation, an umbilico-billary fistula, in a dog. A one-year-old male bulldog was diagnosed with umbilico-billary fistula using fistulography. Treatment involving surgical removal of the fistula was straightforward and resulted in clinical resolution of the problem.

Congenital bronchobiliary fistula: MRI appearance.

Congenital bronchobiliary fistula (CBBF) is a rare anomaly. Twenty-three cases have been reported since the anomaly was first described in 1952. Most of these cases were diagnosed by bronchoscopy, cholangiography, or hepatobiliary nuclear imaging. Our case of a newborn with bilious emesis with CBBF was depicted by T1-weighted gradient-echo MRI sequences.

Congenital bronchobiliary fistula in association with right-sided congenital diaphragmatic hernia.

A case of congenital bronchobiliary fistula is reported in conjunction with another congenital anomaly, right-sided congenital diaphragmatic hernia. The liver was herniated through the diaphragmatic defect into the right chest where a fistula tract was identified from the surface of the liver to the right mainstem bronchus. The patient was treated successfully.

Congenital tracheobiliary fistula.

Congenital respiratory tract-biliary fistula, including tracheo- and broncho-biliary fistulae, are rare developmental anomalies. To date, only 18 cases have been reported. We present two additional cases that came to our attention after a long and difficult attempt to make a diagnosis. After surgical excision of the tract both children have remained symptom-free for 6 and 4 years, respectively. Bronchoscopy allows an early diagnosis, but patients also have to be investigated for associated biliary tree malformations.

[Congenital tracheobiliary fistula]. / Kongenit trakeobiliaer fistel.

A case of congenital bronchobiliary fistula in a three-year old girl is reported. The patient was born after 40 weeks of gestation and referred due to a long history of respiratory tract problems. Bronchoscopy disclosed a third opening at the level of the carina. The opening was cannulated with an X-ray positive catheter, and a fistula crossing the diaphragm and communicating with the left hepatic duct was found. Cholescintigraphic examination (HIDA-scanning) confirmed the presence of the fistula, but found no evidence of abnormalities in the rest of the biliary system. The thoracic portion of the fistula was excised through a right side thoracotomy. The postoperative course was uncomplicated. HIDA-scanning one month after the operation showed normal uptake, and the girl's symptoms had disappeared.

Disorders in foregut diverticulization: congenital hepaticoesophageal fistula in a baby with laryngotracheoesophageal cleft.

Congenital fistulae between the biliary tract and the proximal foregut are rare. Nineteen cases have been reported involving a fistula tract between the left hepatic duct and the distal trachea or proximal bronchus. Herein the authors describe a fistula between the hepatic duct and the esophagus. A baby girl had a type III laryngotracheoesophageal cleft repaired in the neonatal period. In the course of investigating her bilious vomiting a DISIDA scan showed radionuclide excretion into the distal esophagus. A percutaneous cholangiogram through the gallbladder showed no drainage from the common bile duct into the duodenum, while the proximal left hepatic duct drained into the distal esophagus. The fistula was divided adjacent to the esophagus and the biliary system was drained through a Roux-en-Y cholecystojejunostomy. Fourteen months later she is doing well with no evidence of hepatic compromise.