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Bronchobiliary fistula: a case report
1Department of Surgery, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Insights
A rare bronchobiliary fistula in a newborn was successfully treated. This case highlights a rare complication following gastroesophageal reflux surgery, emphasizing prompt diagnosis and intervention for a favorable outcome.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Bronchobiliary fistula is an extremely rare congenital or acquired condition.
- Gastroesophageal reflux is common in infants, often managed with fundoplication.
Observation:
- A newborn presented with severe gastroesophageal reflux requiring surgical intervention.
- Postoperatively, bile was observed in the endotracheal tube, indicating an abnormal connection.
Findings:
- Diagnostic procedures confirmed a bronchobiliary fistula, an abnormal opening between the airway and biliary system.
- Surgical division of the fistula via right thoracotomy resulted in a complete recovery.
Implications:
- This case underscores the importance of considering rare complications after common surgical procedures.
- Early recognition and appropriate management are crucial for successful outcomes in pediatric surgical emergencies.
Abstract:
Fewer than 20 cases of bronchobiliary fistula have been reported in the literature. In this report a newborn female infant was referred for investigation of gastroesophageal reflux. Upper gastrointestinal endoscopy and 24-hour pH monitoring revealed severe reflux. A fundoplication was carried out. In the immediate postoperative period bile was noticed coming from the endotracheal tube. Bronchoscopy revealed an abnormal opening just to the left of the carina. Fistulography and HIDA scanning confirmed the presence of a bronchobiliary fistula. A right thoracotomy was used to divide the fistula. The child made an uncomplicated recovery. Pathological examination of the excised specimen demonstrated tissue most consistent with an esophageal origin.