Article

Pericardiobiliary fistula causing acute pericarditis and tamponade following extensive cytoreductive surgery

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Thoracobiliary fistulas are pathological communications between the biliary tract and the bronchial tree (bronchobiliary fistulas) or the biliary tract and the pleural space (pleurobiliary fistulas). We have reviewed aetiology, pathogenesis, predilection formation points, the clinical picture, diagnostic possibilities, and therapeutic options for thoracobiliary fistulas. A patient with an iatrogenic bronchobiliary fistula which developed after radiofrequency ablation of a colorectal carcinoma metastasis of the liver is present. We also describe the closure of the bronchobiliary fistula with the greater omentum as a possible manner of fistula closure, which was not reported previously according to the knowledge of the authors. Newer papers report of successful non-surgical therapy, although the bulk of the literature advocates surgical therapy. Fistula closure with the greater omentum is a possible method of the thoracobiliary fistula treatment.
Article
Full-text available
Background Cardiac tamponade as the initial manifestation of metastatic cancer is a rare clinical entity. Furthermore, a thoraco-biliary fistula is another rare complication of echinococcosis due to rupture of hydatid cysts located at the upper surface of the liver to the pleural or pericardial cavity. We report a case of non-small cell lung cancer with a coexisting hepatic hydatid cyst presenting as a bilious pericardial effusion. Case report A 66-year-old patient presented with cardiac tamponade of unknown origin. Chest CT-scan demonstrated a left central lung tumor, a smaller peripheral one, bilateral pleural effusions and a hydatid cyst on the dome of the liver in close contact to the diaphragm and pericardium. Pericardiotomy with drainage was performed, followed by bleomycin pleurodesis. The possible mechanism for the bilious pericardial effusion might be the presence of a pericardio-biliary fistula created by the hepatic hydatid cyst. Conclusions This is the first case of a bilious pericardial effusion at initial presentation in a patient with lung cancer with coexisting hepatic hydatid cyst.
Article
A 55‐years‐old Caucasian male presented with chest pain, dyspnea and hypotension four‐months after simultaneous liver and kidney transplantation. His post‐transplant course was complicated with only one episode of acute cellular rejection one month prior to presentation, successfully treated with steroids. His immunosuppression consisted of tacrolimus and mycophenolic acid. Transthoracic echocardiogram (TTE) in the emergency room showed a large pericardial effusion and tamponade physiology. Emergent pericardiocentesis removed 560 mL of bloody fluid (red blood cell count of 6.74 million) and a pericardial drain was placed. Fluid studies including bacterial, fungal, and acid‐fast bacilli cultures, viral PCR (herpes simplex, adenovirus, human herpesvirus 6, cytomegalovirus), histoplasma, coccidioides antigens, and cytology were negative. This article is protected by copyright. All rights reserved.
Article
Biliary stent implantation is an established treatment of biliary strictures. Stent migration has been previously reported to cause bronchopleuralbiliary fistula. We report a case of pericardialbiliary fistula causing cardiac tamponade as a result of biliary stent migration which has been successfully treated with pericardiocentesis and biliary stent retrieval via endoscopic retrograde cholangiopancreatography (ERCP).
Article
Eight cholangio-thoracic fistula patients were seen from 1981 to 1987 in our hospital. The clinical features of the cases were classified into four types, i.e. bronchobiliary fistula (BBF, 3 cases), bronchopleurobiliary fistula (BPBF, 2 cases), pleurobiliary fistula (PBF, 2 cases) and pericardiobiliary fistula (PCBF, 1 case). In addition to a history of cholangitis or cholelithiasis and continuous or intermittent secondary biliary tract infection, the principle manifestations of BBF included: acute, subacute or chronic biliary empyema; biliary pneumonia or biliary lung abscess; and biliptysis. The empyema perforating into trachea, bronchus, pericardium and large vessels in the thoracic cavity may result in serious consequences. Asphyxiation, pericardial tamponade and abrupt massive intrathoracic hemorrhage may also be fatal. It is often difficult to locate the fistula by bronchoscopy, however the bile found in the respiratory tract may suggest BBF. Surgical management of BBF and PCBF are discussed.
Article
Thoracobiliary fistulae are extremely rare complications of thoraco-abdominal trauma and as a consequence no optimal therapy protocol has been agreed upon. We report on such a case. The aggressive surgical approach adopted by thoracic surgeons in previous years, although very successful, has been recently challenged with the advent of the intervention radiologist and endoscopist. The radiologist is capable of percutaneously draining septic foci, whilst the endoscopist as an adjunct to endoscopic retrograde cholangiography can perform sphincterotomy and stent placement for controlling bile fistula drainage. Recent reports of the success with these non-operative measures in the management of thoracobiliary fistulas, has made conservative therapy an appealing option. Conservative therapy not only confirms the diagnosis, but also temporarily stabilises the patient and in some cases may be the only therapy required in the management of such fistulae. Surgical intervention should therefore only be indicated once these conservative measures have failed.