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HPB Surgery
Volume 2011 (2011), Article ID 347654, 4 pages
http://dx.doi.org/10.1155/2011/347654
Case Report

Biliobronchial Fistula after Liver Surgery for Giant Hydatid Cyst

1Unidad de Cirugía General, Fundación Hospital Alcorcón, Budapest 1, Alcorcón, 28922 Madrid, Spain
2Area de Radiología y Medicina Nuclear, Fundación Hospital Alcorcón, 28922 Madrid, Spain
3Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA

Received 1 October 2010; Revised 23 April 2011; Accepted 28 July 2011

Academic Editor: Olivier Farges

Copyright © 2011 Carmelo Loinaz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Biliobronchial fistula (BBF) is a rare complication in the natural history of liver hydatid disease by Echinococcus granulosus. We present a case of BBF after resection of a giant liver hydatid cyst in a 72-year-old woman. Case Report. A total cystpericystectomy was done, leaving the left lateral section of the liver that was fixed to the diaphragm. Postoperatively, the patient developed obstructive jaundice. An ERCP showed an obstruction at the junction of the left biliary duct and the main biliary duct and contrast leak. At reoperation, the main duct was ischemic, likely due to torsion along its longitudinal axis. A hepatotomy was done at the hilar plate, and the biliary duct was dissected and anastomosed to a Roux-en-Y jejunal loop. She was discharged without complications. Five months later, the patient developed cholangitis and was successfully treated with antibiotics. However, she suffered repeated respiratory infections, and four months later she was admitted to the hospital with fever, cough, bilioptysis, and right lower lobe pneumonia. The diagnosis of BBF was confirmed with 9 9 m T c Mebrofenin scintigraphy. At transhepatic cholangiography, bile duct dilation was seen, with a biliothoracic leak. She underwent dilatation of cholangiojejunostomy stricture with placement of an external-internal catheter. The catheter was removed 3.5 months later, and two years later the patient remains in very good condition. Conclusion. An indirect treatment of the BBF by percutaneous transhepatic dilation of the biliary stenosis avoided a more invasive treatment, with satisfactory outcome.