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- W2977992247 abstract "Introduction: Bronchobiliary fistulas (BBF) are rare complications leading to communication between the thorax and biliary system. We present a case of a BBF that developed nearly a decade after pancreaticoduodenectomy (PD) for a neuroendocrine tumor.Figure 2Case: A 70-year-old man with an ampullary neuroendocrine tumor s/p PD complicated by biliary stricture and hepaticojejunostomy (HJ) anastomosis revision, presented with progressive dyspnea, fatigue and iron deficiency anemia attributed to iron malabsorption from prior bowel resections. He was transfused three units of pRBCs and discharged home. However, two days post discharge, he returned with worsened dyspnea, productive cough with bilious sputum. Initial impression was concerning for pneumonia. However, he had significant sputum output and hyperbilirubunemia. Work-up revealed cirrhosis, perihepatic ascites and right pleural effusion on right upper quadrant ultrasound. CT scan demonstrated a diaphragmatic fistula (Figure 1). Cholangiogram demonstrated a stricture at the afferent limb of HJ and biliary duct dilation (Figure 2). He was started on antibiotics and a percutaneous biliary drain was placed. He improved and was discharged. His fistula is now maintained with a biliary drain and he has had no further episodes of bilioptysis. He also receives iron sucrose infusions for chronic iron deficiency anemia.Figure 2Discussion: BBF represents a fistulous tract connecting the biliary system to the thoracic cavity, through the pleural space, lung parenchyma and bronchial tree. Risk factors for development of a BBF include conditions involving the hepatobiliary system including infection, blunt trauma or malignancy. In iatrogenic BBF, prior biliary tract intervention predates presenting symptoms by approximately 6 months. The development of BBF here likely resulted from the biliary-afferent limb anastomotic stricture after PD causing elevated biliary pressure. With the negative pressure in the thoracic cavity, the fistulous tract developed to relieve high pressure in the portal system. As bile is a strong irritant, erosions through the bronchial wall occurred leading to his presentation with bilioptysis. The patient recovered remarkably with conservative management with percutaneous biliary drain. This case highlights one mechanism for development of BBF and demonstrates that conservative management is a viable option in patients deemed to be poor surgical candidates with the potential for favorable outcomes." @default.
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- W2977992247 date "2016-10-01" @default.
- W2977992247 modified "2023-09-27" @default.
- W2977992247 title "Bronchobiliary Fistula: A Rare Complication After Pancreaticoduodenectomy" @default.
- W2977992247 doi "https://doi.org/10.14309/00000434-201610001-01213" @default.
- W2977992247 hasPublicationYear "2016" @default.
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