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[Bronchobiliary fistula]

S Nishimura1, Y Nakagawa, T Sakata

  • 1Department of Internal Medicine, Arao Municipal Hospital, Kumamoto, Japan.

Nihon Kyobu Shikkan Gakkai Zasshi
|June 1, 1996
PubMed
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A rare bronchobiliary fistula, suspected to be caused by congenital syphilis, led to a fatal outcome in a 57-year-old woman. This case highlights the diagnostic challenges and severe complications of this uncommon condition.

Area of Science:

  • Gastroenterology
  • Pulmonology
  • Infectious Diseases

Background:

  • Congenital syphilis can present with rare and severe complications later in life.
  • Bronchobiliary fistula is an uncommon condition characterized by an abnormal connection between the biliary tract and the bronchial tree.

Observation:

  • A 57-year-old woman with congenital syphilis presented with productive cough, fever, cholelithiasis, and paralytic ileus.
  • Clinical and radiological findings suggested aspiration pneumonia and volume loss in the right lung.
  • Bronchoscopy revealed bile in the right basal bronchi, and subsequent surgery identified a gallstone and adhesions.

Findings:

  • A T-tube cholangiogram confirmed a bronchobiliary fistula, with the right hepatic duct communicating with the right basal bronchus.

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  • Despite surgical intervention (ligation of the right hepatic duct), biliptysis persisted.
  • The patient succumbed to rapidly progressing hepatorenal failure.

    • Implications:

    • This case underscores the potential for congenital syphilis to cause rare complications like bronchobiliary fistula.
    • The diagnosis and management of bronchobiliary fistula can be challenging, requiring multidisciplinary approaches.
    • Further investigation into the pathogenesis of syphilis-associated bronchobiliary fistula is warranted.