Anesthetic Management of Bronchobiliary Fistula as a Complication of Liver Hydatid Cyst: A Case Report.

Abstract

Bronchobiliary fistula (BBF) in adults is a quite infrequent complication characterized by the abnormal interconnection between the right bronchial system and the biliary tract. BBF may occur due to various causes, including trauma, infections, malignancies, and complications of certain surgical procedures involving the liver or the hepatobiliary system. In this paper, we report a case of BBF following liver hydatid cyst resection that developed in a 58-year-old Iranian male. The patient had acute dyspnea with yellowish sputum. After diagnostic measures such as bronchoscopy, computed tomography (CT) scan, endoscopic retrograde cholangiopancreatography (ERCP), and confirmation of the diagnosis of BBF, the patient underwent Intravenous (IV) antibiotic therapy, placement of pleural drain, sphincterotomy and CBD stents insertion but unfortunately, these measures were not effective and the patient was a candidate for thoracotomy and resection of fistula and the involved lung. During surgery, absolute lung isolation was done by insertion of a left-sided double-lumen endobronchial tube and uneventful anesthesia was maintained for about 5 hours. Patients with BBF present unique challenges in terms of anesthetic management. Sepsis, pulmonary impairment, electrolyte imbalances and malnutrition will make anesthesiologists face many perioperative challenges. During surgery, absolute lung isolation is typically necessary and achieving effective lung isolation can be quite challenging due to the presence of the fistula. Postoperatively, intensive respiratory support, chest tube drainage, and appropriate antibiotic therapy may be required .In addition, a multidisciplinary approach involving anesthesiologists, thoracic surgeons, and other specialists is crucial.