BILIOBRONHIJALNA FISTULA NASTALA KAO POSLEDICA EHINOKOKNE BOLESTI JETRE I HOLEDOHOLITIJAZE.

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    • Alternate Title:
      BILIOBRONCHIAL FISTULA DUE TO HYDATIDOSIS OF THE LIVER AND CHOLEDOCHOLITHIASIS.
    • Abstract:
      Introduction Biliobronchial fistula (BBF) is an abnormal communication between the biliary system and bronchial tree due to trauma, hemiheptectomy benign biliary stricture with cholangitis and necrotic hepatic infections such as hydatid disease. Intratoracic rupture of a hydatis cyst of the liver is a rare but severe complication with an incidence about 1% and mortality rate about 10%. Case report A 50-year-old male patient presented with cough, episodes of biliary expectoration and haemoptysis followed with fever, fatigue and dyspnea. The diagnosis was set by echosonography, Chest x-ray finding, CT scan, bronchoscope aspirates while bronchography did not show results. The surgery was done through right subcostal laparotomy. A hydatid cyst was found in the right liver lobe its diameter being 10 cm, fixed with diaphragm. Intraoperative cholangiography revealed choledocholithiasis (two calculi), dilatation of bile ducts and communication of right hepatic duct with the irregular liver cavity as well as with the bronchi of the right lower pulmonary lobe. Cholecystectomy, choledocholitotomy with drainage lavage of bile ducts pericystectomy and cyst evacuation was performed, followed by diaphragm necrosectomy. The postoperative period and control cholangiography through T drain were normal. Discussion The surgical treatment has five goals: to treat the liver cyst, secure free biliary drainage, perform hepatodiaphragmatic disconection, solve intratoracic lesion and restore ti diaphragm. We believe these goals could be achieved through abdominal approach except for irreversible bronchiectasis, intratoracal collection and chronic pulmonary sepsis. Conclusion In any case, a surgery still remains the treatment of choice in cases of echinococcosis. Most cases can be solved by laparotomy. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Biliobronhijalna fistula je patološka komunikacija između žučnih vodova i bronhijalnog stabla. Intratorakalna ruptura ehinokokne ciste jetre je retka ali teška komplikacija sa stopom mortaliteta koja iznosi 10%. Prikazujemo 50 godina starog bolesnika sa kašljem, povremenim iskašljavanjem žuči, hemoptizijama koje su praćene povišenom temperaturom, otežanim disanjem i slabošću. Dijagnoza je postavljena ehosonografijom, radiografijom pluća, skenerom grudnog koša i trbuha kao i bronhoskopijom sa biohemijskom analizom bronhijalnog aspirata. Hirurški pristup je bio desna supkostalna laparotomija. Viđena je cista u desnom režnju jetre, promera 10 cm, fiksirana za dijafragmu. Intraoperativna holangiografija je dokazala holedoholitijazu, dilataciju žučnih vodova kao i komunikaciju žučnih vodova sa nepravilnom šupljinom u desnom režnju jetre koja je u komunikaciji sa bronhijalnim stablom. Urađena je holecistektomija, holedoholitotomija sa T-drenažom, pericistektomija i evakuacija sadržaja ciste kao i ekscizija nekrotičnog tkiva dijafragme i sutura plućnog parenhima. Operacija je završena drenažom pleuralnog prostora i dvostrukom drenažom desnog supfreničnog prostora. Postoperativni period je protekao bez komplikacija. Kontrolna holangiografija je pokazala uredan nalaz. Tri godine nakon operacije pacijent je bez simptoma. [ABSTRACT FROM AUTHOR]
    • Abstract:
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