A Case of Biliary Pneumonia Successfully Treated with Embolization through Percutaneous Transhepatic Cholangiodrainage Tube for Bronchobiliary Fistula after Surgery

Abstract

Braonchobiliary fistula is a rare condition and intractable. We present a case of biliary pneumonia successfully treated with embolization through a percutaneous transhepatic cholangiodrainage tube for bronchobiliary fistula after surgery. A 64-year-old man received total gastrectomy with lymphadenectomy, partial hepatectomy, splenectomy and distal pancreatectomy for advanced gastric cancer. Eighteen months after surgery, a partial hepatectomy was performed to treat a hepatic recurrence. Because of severe adhesion, his right lung and diaphragm were injured and repaired intra-operatively. Two years after the partial hepatectomy, multiple liver metastases reappeared. Around the same time, feverance and bilious sputum also appeared. He was diagnosed with bilious pneumonia secondary to bronchobiliary fistula. Bilious pneumonia improved temporarily by antibiotic medication, but relapsed repeatedly. Percutaneous transhepatic cholangiodrainage was performed to reduce the biliary pressure, but the symptoms did not improve. Finally, he was completely cured by transbiliary embolization of the fistulae through a percutaneous transhepatic cholangiodrainage tube. We think that transbiliary embolization of intractable bronchobiliary fistula was a safe and effective treatment.