Korean J Transplant.  2023 Dec;37(4):293-298. 10.4285/kjt.23.0044.

Delayed diagnosis of bronchobiliary fistula complicating a pediatric living donor liver transplantation: a case report

• Gautam V
• Kumar V
• Agarwal S
• Gupta S

• KMID: 2550241
• DOI: http://doi.org/10.4285/kjt.23.0044

Abstract

Bronchobiliary fistula (BBF) is a very rare condition in children. Only a few pediatric BBF cases have been reported, in the context of a ruptured hydatid cyst or liver abscess. BBF after living donor liver transplantation (LDLT) has not been reported in the pediatric literature. We report a 7-year-old female child with Wilson disease, who developed BBF post-LDLT. She had a clinically uneventful course in the immediate post-transplant pe-riod. She was readmitted on postoperative day (POD) 75 with a productive cough and respiratory difficulty, which was diagnosed as bilioptysis secondary to BBF. Endoscopic retrograde cholangiopancreaticography was attempted but failed. Exploratory laparotomy showed a fistula from the strictured biliary anastomotic site to the right thoracic cavity; it was excised, and a Roux-en-Y hepaticojejunostomy was performed. She tol-erated the procedure well and remained clinically well on follow-up through POD 185. BBF is extremely rare in children. This is the first case report of BBF in a child following LDLT. BBF requires a high index of suspicion for a timely intervention to prevent subsequent complications.

Keyword

Bronchobiliary; Fistula; Liver; Transplant; Children

Figure

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  Fig. 1 (A) Chest X-ray, posteroanterior view, showing confluent nonhomogeneous opacities in the right lower zone obscuring the diaphragm and right cardiac border with mild right-hand pleural effusion. (B) Computed tomography showing consolidation of the right lung.

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  Fig. 2 Bilioptysis: yellow-colored bilious sputum. (A) Cup containing yellow colored sputum (bilioptysis), shown by parents in the outpatient clinic. (B) Tray showing yellow sputum after the admission to the intensive care unit

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  Fig. 3 Bronchobiliary fistula: communication from the strictured duct-duct anastomotic site to the right-hand thoracic cavity. (A) Before and (B) after examination of fistula tract by metallic probe (indicated by arrows).

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