Korean J Hepatobiliary Pancreat Surg.  2012 Aug;16(3):110-114. 10.14701/kjhbps.2012.16.3.110.

Successful percutaneous management of bronchobiliary fistula after radiofrequency ablation of metastatic cholangiocarcinoma in a patient who has a postoperative stricture of hepaticojejunostomy site

Affiliations
  • 1Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea. Knife@wonkwang.ac.kr

Abstract

Bronchobiliary fistula (BBF) is a rare condition that is defined as an abnormal communication between the biliary system and bronchial tree. Furthermore, a BBF is an extremely rare complication of radiofrequency ablation (RFA). A 54 year-old man with a history of extrahepatic biliary cancer had been suffering with a benign stricture of hepaticojejunostomy site and was treated with RFA for metastatic cholangicarcinoma. In this report, we describe a patient with BBF complicated by an abscess which occurred after RFA. He was treated by placement of external drainage catheter into the liver abscess and percutaneous transhepatic biliary drainage (PTBD) into the right intrahepatic duct. After 6 weeks, a complete obliteration of the BBF was confirmed by a repeated follow-up of computed tomography scan and cholangiography through PTBD.

Keyword

Biliary fistula; Cholangiocarcinoma; Catheter ablation; Bronchial fistula

MeSH Terms

Abscess
Biliary Fistula
Biliary Tract
Bronchial Fistula
Catheter Ablation
Catheters
Cholangiocarcinoma
Cholangiography
Constriction, Pathologic
Dioxolanes
Drainage
Fistula
Fluorocarbons
Follow-Up Studies
Humans
Liver Abscess
Stress, Psychological
Dioxolanes
Fluorocarbons

Figure

  • Fig. 1 A computed tomography scan obtained two weeks after radiofrequency ablation shows that the previously ablated area has become hypodense with area formation, which was identified as a liver abscess (arrow).

  • Fig. 2 A follow-up computed tomography shows liver abscess with inserted pigtail catheter in the previous radiofrequency ablated site (black circle) and consolidation with air formation in the adjacent diaphragm, which was diagnosed as a lung abscess (white circle).

  • Fig. 3 Contrast material was injected through the percutaneous abscess drainage catheter. This contrast material showed in the abscess cavity in liver (black arrow), bronchial tree (thin white arrow), and biliary tree (wide white arrow), confirming the presence of bronchobiliary fistula.

  • Fig. 4 Although the amount of sputum decreased after the insertion of the drainage catheter, bilioptysis and coughing continued. We performed percutaneous transhepatic biliary drainage (PTBD) in the dilated right hepatic duct to reduce the intrahepatic biliary tree pressure which was increased due to the hepaticojejunostomy site stricture.

  • Fig. 5 One month later, the follow-up coronary computed tomography image shows improvement of liver abscess and no consolidation of lower lung field.

  • Fig. 6 After the percurtaneous drainage catheter was removed, contrast material was injected through PTBD catheter. Cholangiography shows no communication between the bronchial system and biliary tree.


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