A biliary fistula is a type of

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

in which

bile Bile (from Latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine. In humans, bile is produced continuously by the liver (liver bi ...

flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include: * bilioenteric fistula: abnormal connection to small bowel, usually duodenum. * thoracobiliary fistula: abnormal connection to pleural space or bronchus (rare). * bronchobiliary fistula: pathological communication between a bronchus and the biliary tract (extremely rare). These may be contrasted to a

bile leak A biliary fistula is a type of fistula in which bile flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include: * bilioenteric fistula: abnormal connection to small bowel, usually duodenum ...

, in which bile escapes the bile ducts through a perforation or faulty surgical

anastomosis An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be norm ...

into the abdominal cavity. Damage to a bile duct may result in a leak, which may eventually become a biliary fistula.

Signs and symptoms

A biliary fistula often occurs in be suspected in a person who has recently undergone a surgical procedure. Pain may occur if the leaked bile is also infected, which can subsequently lead to biliary

peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part o ...

. Brochobilary fistula is challenging because patients may have a repeated chest infection, pleural effusion, and perihepatic abdominal collection. The patients usually present with bilioptysis (presence of bile in sputum), persistent cough, chest infections, or respiratory distress due to pleural effusion. Bilioptysis is the pathognomonic clinical feature of BBF. Extensive

ascites Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, a ...

may accumulate, especially in the setting of sterile bile leakage, which is often

asymptomatic In medicine, any disease is classified asymptomatic if a patient tests as carrier for a disease or infection but experiences no symptoms. Whenever a medical condition fails to show noticeable symptoms after a diagnosis it might be considered a ...

in nature.

Causes

It can occur as a complication following biliary

trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...

(such as

cholelithiasis A gallstone is a stone formed within the gallbladder from precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to the presence of mig ...

), as an

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...

effect or as a result of a penetrating injury. Bronchobilary fistula commonly caused by primary and metastatic tumors, bile duct obstruction secondary to biliary stenosis, cholangiolithiasis, hepatic hydatidosis and trauma.

Diagnosis

For bronchobilary fistula, the following tests are performed: 1) ultrasound abdomen, may show subdiaphragmatic collection around the surface of the right lobe of the liver. 2) preoperative chest X-ray, may demonstrate mild to moderate right-sided pleural effusion without an active lung pathology. 3) CT scan, may reveal focal collection along the liver's right lateral margin, which can be communicating with one of the right lower lobe bronchi, supporting the diagnosis of a BBF.

Treatment

Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries.

References

External links