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- Title
Non-Operative Management of Bronchobiliary Fistula Due to Proximal Migration of Biliary Stent in a Patient With Unresectable Klatskin Tumor.
- Authors
Tsema, Ievgen; Slobodianyk, Viktor; Rahushyn, Dmytro; Myrhorodskiy, Denys; Yurkiv, Oleh; Dinets, Andrii
- Abstract
Introduction: One of the methods for the biliary tree decompression in the case of Klatskin tumor is transpapillary stenting, which could be completed by stent migration in 4% to 10% of cases. Approximately half of the stent migrations are in the proximal direction. In this study, we reported a rare case of proximal trans-diaphragmatic stent migration to the lower lobe of the right lung with the formation of a biliary-bronchial fistula (BBF). Case presentation: A 60-year-old woman was diagnosed with hilar cholangiocarcinoma (type 3B by Bismuth-Corlette) complicated by posthepatic jaundice. To relieve jaundice there were performed endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, endobiliary stent placement (10 Fr, 150 mm). A restenting (11.5 Fr, 130 mm) was performed in 2.5 months due to endobiliary tube occlusion. In the next 2 months, coughing attacks and biliptysis have appeared in the patient. A CT scan showed penetration of the liver, diaphragm, and lower lobe of the right lung with the proximal part of the stent and caused BBF formation. Anti-inflammatory and antibacterial therapy was administrated for 14 days and BBF was closed. Stent retrieval from the right hemithorax and endobiliary restenting was performed in 9 months after primary stenting. During follow-up, appropriate positioning and functioning of the stent were observed. Conclusion: BBF formation is a rare complication of endobiliary stenting, which can be successfully treated by anti-inflammatory and antibiotic therapy, followed by transpapillary stent retrieval.
- Subjects
JAUNDICE treatment; ANTIBIOTICS; DIAGNOSIS of digestive system diseases; FOREIGN body migration; FISTULA; DIGESTIVE system diseases; MEDICAL device removal; ANTI-inflammatory agents; BRONCHIAL fistula; ENDOSCOPIC retrograde cholangiopancreatography; SURGICAL stents; BILE duct adenocarcinoma; MAGNETIC resonance imaging; BILIARY tract; COMPUTED tomography; RARE diseases; SPHINCTERECTOMY; DISEASE complications
- Publication
Clinical Medicine Insights: Case Reports, 2021, p1
- ISSN
1179-5476
- Publication type
Article
- DOI
10.1177/11795476211043067