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Bronchobiliary fistula: a rare complication of hepatic endometriosis
Jochen Schuld1, Christoph Justinger, Mathias Wagner
1Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany.
Objective:
To report the case and surgical therapy of a patient with bilioptysis after vaginal delivery, caused by bronchobiliary fistula. Histologic analysis revealed endometrial glands embedded in the decidual stroma neighboring the liver and the lung.
Design:
Case report.
Setting:
University hospital.
Patient(S):
A 39-year-old patient, 7 days after vaginal delivery, without endometrial history.
Intervention(S):
Synchronous liver and lung resection of a bronchobiliary fistula by laparotomy and a transdiaphragmatic approach.
Main Outcome Measure(S):
For complicated brochobiliary fistula caused by endometriosis, radical surgical treatment is mandatory.
Result(S):
Histopathologic analyses confirmed the presence of clusters of endometrial glands embedded in the decidual stroma that were neighboring the liver, and perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives.
Conclusion(S):
Hepatic and perihepatic endometriosis can cause a bronchobiliary fistula. Exacerbation of the symptoms can be triggered by high estrogen levels, physiologically dominating the last trimester. For such a rare case, surgery is mandatory.
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