Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child
Prawin Kumar1, Poonam Mehta1, Javed Ismail1
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
A rare bronchobiliary fistula (BBF) in a child, caused by a ruptured liver abscess, was successfully treated with surgery. This case highlights effective management of this complex biliary tract and bronchial tree communication.
Area of Science:
- Medicine
- Pediatrics
- Surgery
Background:
- Bronchobiliary fistula (BBF) is an uncommon condition characterized by an abnormal connection between the biliary tract and the bronchial tree.
- Ruptured liver abscess is a potential, though rare, cause of BBF development.
Purpose of the Study:
- To report a pediatric case of bronchobiliary fistula following a ruptured liver abscess.
- To describe the diagnostic and surgical management of this rare condition in a child.
Main Methods:
- Case presentation of a 3½-year-old child with BBF.
- Initial treatment involved exploratory laparotomy and peritoneal wash for a ruptured liver abscess.
- Subsequent diagnosis via identification of the abnormal communication, followed by surgical excision (right lateral thoracotomy, right lower lobectomy, and sinus tract excision).
Main Results:
- The child presented with fever, cough, and bilioptysis seven months after initial treatment for a ruptured liver abscess.
- An abnormal communication was confirmed between the right hepatic duct and the right main bronchus.
- Surgical intervention resulted in complete resolution of symptoms, with the child remaining asymptomatic post-operatively.
Conclusions:
- Surgical management, including excision of the sinus tract, is effective for treating pediatric bronchobiliary fistula.
- Prompt diagnosis and intervention are crucial for favorable outcomes in cases of BBF secondary to liver abscess rupture.
Abstract:
Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.
