CardioVascular and Interventional Radiology

, Volume 28, Issue 6, pp 828–831 | Cite as

Bronchobiliary Fistula Treated by Self-expanding ePTFE-Covered Nitinol Stent-Graft

  • Roberto Gandini
  • Daniel KondaEmail author
  • Giuseppe Tisone
  • Vincenzo Pipitone
  • Alessandro Anselmo
  • Giovanni Simonetti


A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula.


Bilioptysis Bronchobiliary fistula Cholangiocarcinoma Covered stent Jejunostomy 


  1. 1.
    D’Altorio, RA, McAllister, JD, Sestric, GB, Cichon, PJ 1992Hepatopulmonary fistula: Treatment with biliary metallic endoprosthesisAm J Gastroenterol87784786PubMedGoogle Scholar
  2. 2.
    Kabiri, EH, El Maslout, A, Benosman, A 2001Thoracic rapture of hepatic hydatidosis (123 cases)Ann Thorac Surg7218831886CrossRefPubMedGoogle Scholar
  3. 3.
    Brunaud, L, Sebbag, H, Bresler, L, Tortuyaux, JM, Boissel, P 2000Left hepatic duct injury and thoracobiliary fistula after abdominal blunt traumaHepatogastroenterology4712271229PubMedGoogle Scholar
  4. 4.
    Kabiri H, Chafik A, al Aziz S, el Maslout A, Benosman A (2000) Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy. Ann Chir 125:654–659CrossRefPubMedGoogle Scholar
  5. 5.
    Moumen, M, el Fares, F 1991Bilio-broncliial fistula of hydatid originApropos of 8 cases. J Chir128188192Google Scholar
  6. 6.
    Rose, DM, Rose, AT, Chapman, WC, Wright, JK, Lopez, RR, Pinson, CW 1998Management of bronchobiliary fistula as a late complication of hepatic resectionAm Surg64873876PubMedGoogle Scholar
  7. 7.
    Choi, JW, Kim, TK, Kim, KW, Kim, AY, Kim, PN, Ha, HK, Lee, MG 2003Anatomic variation in intrahepatic bile ducts; an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantationKorean J Radiol48590PubMedGoogle Scholar
  8. 8.
    Schwartz, ML, Coyle, MJ, Aldrete, JS, Keller, FS 1998Bronchobiliary fistula: Complete percutaneous treatment with biliary drainage and stricture dilationRadiology168751752Google Scholar
  9. 9.
    Sherman, S, Shaked, A, Cryer, HM, Goldstein, LI, Busuttil, RW 1993Endoscopic management of biliary fistulas complicating liver transplantation and other hepatobiliary operationsAnn Surg218167175PubMedGoogle Scholar
  10. 10.
    Davids, PH, Rauws, EA, Tytgat, GN, Huibregtse, K 1992Postoperative bile leakage: Endoscopic managementGut3311181122PubMedGoogle Scholar
  11. 11.
    Brem, H, Gibbons, GD, Cobb, G, Edgin, RA, Ellison, EC, Carey, LC 1990The use of endoscopy to treat bronchobiliary fistula caused by choledocholithiasisGastroenterology98490492PubMedGoogle Scholar
  12. 12.
    Krige, JE, Bornman, PC, Beningfield, SJ, Nieuwoudt, JH, Terblanche, J 1990Endoscopic embolization of external biliaiy fistulaBr J Surg77581583PubMedGoogle Scholar
  13. 13.
    Herold, G, Danz, B 1995Endoscopic (-ERC) fibrin sealing and histoacryl sealing of an abscess induced bilio-hepatico-cutaneous and a bilio-hepatico-phrenico-bronchial fistulous systemZ Gastroenterol33605609PubMedGoogle Scholar
  14. 14.
    Gorich, J, Rilinger, N, Sokiranski, R,  et al. 1996Percutaneous transhepatic embolization of bile duct fistulasJ Vasc Interv Radiol7435438PubMedGoogle Scholar
  15. 15.
    Oliva, VL, Nicolet, V, Soulez, G,  et al. 1997Bilomas developing after laparoscopic biliary surgery: Percutaneous management with embolization of biliary leaksJ Vasc Interv Radiol8469473PubMedGoogle Scholar
  16. 16.
    Memis, A, Oran, I, Parildar, M 2000Use of histoacryl and a covered nitinol stent to treat a bronchobiliary fistulaJ Vasc Interv Radiol1113371340PubMedGoogle Scholar
  17. 17.
    Jung, SI, Goo, JM, Han, JK,  et al. 2003Recurrent bronchobiliary fistula: unsuccessful management with repeated insertion of metallic biliary stentJ Vasc Interv Radiol1415771579PubMedGoogle Scholar
  18. 18.
    Warwick, RJ, Davidson, B, Watkinson, A 1999Successful use of a covered nitinol self-expanding stent to seal a malignant fistula of the common bile ductClin Radiol54410412PubMedGoogle Scholar
  19. 19.
    Nishimine, K, Saxon, RR, Kichikawa, K,  et al. 1995Improved transjugular intrahepatic portosystemic shunt patency with ePTFE-covered stent-grafts; Experimental results in swineRadiology196341347PubMedGoogle Scholar
  20. 20.
    Haskal, ZJ 1999Improved patency of transjugular intrahepatic portosystemic shunts in humans: Creation and revision with PTFE stent-graftsRadiology213759766PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Roberto Gandini
    • 1
  • Daniel Konda
    • 1
    Email author
  • Giuseppe Tisone
    • 2
  • Vincenzo Pipitone
    • 1
  • Alessandro Anselmo
    • 2
  • Giovanni Simonetti
    • 1
  1. 1.Department of Diagnostic Imaging and Interventional RadiologyUniversity of Tor VergataRomeItaly
  2. 2.Department of SurgeryUniversity of Tor VergataRomeItaly

Personalised recommendations